Laserfiche WebLink
Date� Z � y- <br />,. Applicalion For <br />PUBLIC WORKS <br />Print or Type Only <br />TO PQSTING �-� � -�u <br />P.ERMIT <br />Pa���� <br />Public Woiks Permit ��.�� _/ <br />Biaq Dao�. • <br />Pu�hc Worxs Fee <br />Totrl Fee s <br />LE55 AOPL FB¢ Pd�O S� <br />Balancc0ue a �n� <br />;_ On2-322yo/Y93/ G�nw - �,'4— �i!f� <br />� <br />�. vT �'� T�2� ��_ � L�. ��( ,.�51 �'�,er�,� l,� A, �h�'i� �z- S, , � <br />Owner Mailina Address �-� C��v � ��.. o�,,...., <br />Describe Proposed Work <br />Projecl Address (il known� <br />Attach four (4) copies ot plans for proposed work • Draw to scale antl note the lol!owing as applicable: <br />� Property Lines <br />• OuNine and dimensions of all existing and <br />proposed structures on the bt <br />• Existiny and proposed utilities <br />• Cen�erline ol sireet <br />• Indicate Norlh <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 O. <br />2. AII work shall be performed in accordance v:ith this permit and current City ot Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />7, �-(�Gr,� �o <br />by /�UGLi� <br />bE' dan� per <br />IvorkS Oh <br />pY'ac✓//�� <br />/z- 2-9�f-_ <br />�LLfi� � ca-f'��� / � f <br />�pproved lor O nsttvction Date <br />�� . <br />�.��.�_ :� ���. ,� <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEFARTMENT <br />3200 Cedar Sireet <br />Everelt, WA 98201 <br />Phone:259-8810 <br />Q�n�nve d <br />���ya�����) <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />0 <br />a <br />The undersigned owne�/applicant hereby agrees to hold and save harm� <br />less tlie City of Everett Irom any and all claims lor damages, cosls, <br />ezpenses, or causes ol aclion ihat may arise because ol installation <br />and maintenance of lhe improvement or other right-ol-way use hereto <br />applied for and further agrees to remove same upon nolice irom the <br />City and to replace puUlic property da ged thereby. <br />� �(,�� ���_� �z.-�-�� <br />SignaWre ol Apphcant 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 MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />