Laserfiche WebLink
Date—!.�'zi�:. -�7 <br />� Application For <br />PUBLIC VVORKS PERMIT <br />Print or Type Only <br />,l..l'7� �L%i i' t-�r`� ��%�% <br />Owner Mailing <br />Public Wo�ka Permil • �� �"'� r <br />BIJp. Depl. � %�� � I Q� <br />Pu011c WorMn Fea s <br />Totel Fea <br />Losf ApO� Fee Pald S <br />Balence Oue S ��� ��' <br />Phone <br />�p li!� Mailing Address Cily 2ip Phone <br />Describe Proposed Work � �� ir <br />Project Address (if known) <br />Attech lour (4) copias of plans for proposed work - Draw to scale and note the tollowing as applicable: <br />• Property Lines .• Centerline of street <br />• Outltne and dimen�ions of all existin9 and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing end proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shail be made 24 hrs in advance - phone 259•881 5. <br />2. AII work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications <br />3. Call Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•800-424• 555. <br />� �e � � .� . �-�-1� �� <br />�oN�J � /,�_-- �� <br />�� ��% ha�'" � �i�`� ,a <br />�r � � � , �.�o ` , �� <br />u .� � 1 % �, � � �� <br />r� °� c�/ � � ,��',-� „� <br />�� s <br />��.�.��� � z.� a� <br />Approved for Con truction Date <br />�/�/%—O % <br />p . R52F.�! Date <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />� ` f. ,r�_ � <br />����� � <br />ACKNOWLEDGEMENT OF <br />� <br />� <br />H, <br />V�' <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold antl save harm- <br />less the City of Everett irom any and all claims for damages, costs, <br />expenses, or causes ol action that may arise because of installation <br />and maintenance of the improvement or other right-ol-way use herato <br />applied for and lurther agrees to remove same upon notice from the <br />City an o re ce public property damaned thereby. <br />� — a�,l—�� <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT �S ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TH�S <br />PROJECT OVER 90 DAYS DURATION. <br />