Laserfiche WebLink
Date_L�� <br />Applic�lion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />P�etlm \vo�As Per r <br />oi�n oeo�. • � �.� <br />PueLc wmFs Fco S <br />ta�N L Ce — <br />L¢554p01 F9C Paitl S -- <br />�TltfifC �YC � <br />Describe Proposed Work <br />Mailinq Address City Z,p Phone <br />Prolect Address lil koown� �� �y �=`-�' • " <br />Attach tour 14) copies ol plans lor proposed work - Draw to scale and note Ihe followinc� as apPlicable: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposetl siruCturPs on the lot <br />• Ezlsting and proposed utiliGes <br />• Cenlerline oi ' <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremenis <br />LI <br />PERMIT CONDITIONS <br />1. All calls for inspeclion shall be made 24 hrs. in advance - phone 259•8810. <br />2. All �•:ork shall be pedormed in accordance with this permit and current City of Everett Design 2nd Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />i`� <br />Approved lor Consiruction Dale <br />FINAL INSPECTION <br />Approved as Consirucb�d <br />ever�tt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt IYA 98201 <br />Plionc:259�8810 <br />��'c�i �e.D <br />���� <br />/D a�89 <br />/1CKNOWLEDGEMENT OF CONDITIOiVS <br />F- <br />N <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less Ihe City of Everett irom any and ail claims lor damages, costs. <br />etpenses, or causes ot aclion Ihat ciay arise 6ecause of installa�io� <br />and maintenance ol the improvement or o0ier nghhof-wey use hcre�o <br />appli?d for and Wrthei agrees to remove same upon no'ice Irom the <br />City and to replace public properry damaged thereby. <br />Signature ol Applicanl Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS '�SUED AND THEREAFTER IS TO <br />BE D�LIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY R[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF N'ORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />