Laserfiche WebLink
Date� � 7 <br />Ppp�ication For <br />PUBLIC VI�ORKS PERMIT <br />Print or Type Unly <br />Owner <br />Applicant <br />Describe Propcsed Work <br />Pro�ect Address (if known) <br />Mailing <br />MUiling Atltlfess <br />.�9/3 <br />Zip <br />Pu01ic Worka Permii • �� /�� <br />eiec. oan�.• <br />PuElm V: orks Fee <br />Tolai Fee s <br />Leas Fp01. Fee Paitl S <br />Oalanca Oue S ���� <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Properly Lines • Centerline of street <br />• Outline and dimensions of al! existing and • Indicate North <br />proposed structures onthelot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in aAvance - phone 259•8815. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Ce�l Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� ~D� f;9dF�E�- /�E2 STl�, 30-3 <br />�' S`!'/1EET �E��i' � Cp/n/�GG�Yr L/FT <br />�5'Ei✓E2 OE.�T TO <br />W <br />H <br />� <br />� <br />O <br />�/>��/ST %�7jqNNOL�S TO V' .P�AE. � <br />� <br />�5/li/07 � <br />/ <br />:f00D86714 � <br />DRVU'J 420.00 <br />LRSH s20,00 <br />�QP.C" �-'�'.r' PLA�/ lJ.9Tr0 <br />Date <br />Approved as Constructed <br />everett FUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt, WA 98201 <br />Phone: 259-8815 <br />�:�6FH OOORH531.i <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and sa� � harm• <br />less the City of Evarett from any and all claims for damages, costs, <br />expenses, or causes of action that may ari�:e berause of instcllation <br />and maintenance of Ihe improvement or other dgel-ot-way use hereto <br />applied lor and further agrees to remove same upon notice from the <br />City and to ieplace public property damaged thereby.���^�r�] <br />�.�,L� N �� <br />s �k —� <br />Signature oi App�i n Date <br />WORK AUTHORI ED BY THIS PERMIT MUST BE STARTED W�THIN <br />180 DAYS OF DATE PERIAIT IS 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 THIS <br />PROJECT OVEF 90 DAYS DURATION. <br />