Laserfiche WebLink
oe�e 3 /� � � ,� ��► <br />Applicat�on For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />F� <br />Deacribe Proposed Work _ <br />Mailing Address <br />O <br />Pu�11CWorh�Ps�m11• '7J'�� <br />BIAp. Oapl. • <br />� ��� <br />Puol�c works Faa � <br />TOI�I Fea — <br />Leee AOP� Foe Pe1E i p�/� <br />BalencnDue i ��=L�v <br />���y <br />`�nz11y,�JtIlL1� �i�4�'Z- <br />City Zip Phi <br />Giry up rnone <br />Project Address (it known) '�1`''�+�'/ v va ' • • - - <br />Attech lour (4) copies of plens for proposed work - Draw to scale and notr, the following as applicable: <br />� Proparty lines <br />� Oulline and dimensions of all existing and <br />proDosed structures on the lot <br />• Existing and proposed utilities <br />� Center�ine of street <br />• Indicate North <br />• Show any proposed gratling changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calis for i�spection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All wo�k shall be peAormed in accordance with this permit and current Ciry of Everett Design and Construction <br />Standards and Specifications <br />3. Call Location Underground Service 48 hrs. before you Aig. TOLI FREE NUMBER 1-800•424-5555. <br />7, ���( [i,n4'.cJ:4�.' /�G���L'f�2� <br />�z.�'.�ca�_ 3�s�/t3s <br />Approved lor Conslructiaf� � �e <br />Q�,w.,, � . � � 191sc� <br />FINAL INS'ECTION Date <br />Approved a: Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />, I� ?t.G ('LGi1Q�f-�j <br />Z �% <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owrer/applicant hereby agrees to ho�d and save harm• <br />less the Ciry of Everett from any anA all claims for damages, costs, <br />expenses, or causes of action that may arise because of inStallation <br />and mainle .:e of the improvemenl or olher right-of-wey use hereto <br />applied fo a d iuriher a rees to remove same upon notice from the <br />City ar}j r place publit�pr�rty damaged thereby. <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STAf7TED WITHIN <br />180 DAYS OF DATE PERMIT 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 OIJ THIS <br />PROJECT OVER 90 DAYS DURATION. <br />