Laserfiche WebLink
Date 4-,, <br />Application For <br />PUBLIC WORKS PERMIT <br />Print of Type only <br />/ WlOS3 <br />Describe Proposed Work <br />Pr0)eat Address (if known) <br />Nbl-c work. PttmP <br />eba DMI • l�1 <br />PUGYc WOrAr FN <br />L.M AW FN P,.a f <br />ZIp Phone <br />Attach four (4) CdPies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centarline of street <br />• Outline and dimensions of ali existing and • Indicate North <br />Proposed structures on the lot • Show an <br />• Existing and proposed utilities Y proposed eroding chan�ea <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All Caps for Inspection Shall be made 24 het in advance - phone 259. MI5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hr& before you dog. TOLL FREE NUMBER 1-800-424.5555. <br />Approved 'or Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett WA 98201 <br />Phone: 259-9815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />cc <br />M <br />0 <br />z <br />0 <br />0 <br />ani <br />The undersigned owner/applicant hereby agrees to hold and save harm. <br />lez; the City of Everett from any and ail Claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the ImprowmeM or other right-of-way use hereto <br />applied for and further agrees to remove some upon notice from the <br />City and to rep'ace Public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED 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 ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />