Laserfiche WebLink
Date �����v" <br />Application For <br />PUBLIC WORKS PERPAIT <br />Print or Type Only <br />Applicant <br />Mailing Address <br />Mailing Address <br />Describe Proposed Work ��llt".r�( JI f"�LI . <br />Prolect Address (il known) <br />vuei�c Wo�6s Pcimn .�y I''� <br />OIaB Depl. a �l�i G�� <br />Pu�Lc WorFs Feo <br />Tolal Fec $ <br />Less APpI Fae PaN � <br />BNanceOue S <br />Gty <br />City Zip Phone <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions �f all existing and <br />proposed slructures on the lot <br />• Existing and proposed utili�ies <br />• Centerline ol street <br />• Intlicate Nor�h <br />• Show eny pro{.osed giading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be peAormed in accordance with this rermit and current City ol Everett Design and Construclion <br />Standa� Js and Specifications. <br />3. Call Location Underground Service 48 hrs. before you di�. TOLL FREE NUMBER 1•800•424-5555. <br />�1�T �t�C�l 1�e �� <br />, <br />4��G c,' � �.�� [i�� <br />Approved for Construction Dale <br />fINAL INSPECTION Date <br />Approved as Construded <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 CedarStreet <br />Evere1L WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ownedapplicanl hereUy agrees to hold and save harm� <br />less the City of Everel� Irom any and all claims for damages. cosis, <br />ezpenses, or causes ol action Ihat may arise because ol installation <br />and maintenance of the improvemenl or other nghPobway use herclo <br />applied lor and luriher agiees �o remove same upon notice Irom the <br />City and to replace public properly damaged Ihereby <br />Signalure ol Applican� Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATF PERh11T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY DE <br />CANCELLED BV THE GTY UPON ANY STOPPAGE OF 1NORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />