Laserfiche WebLink
Date���`_��� <br />ApplicaN�n For <br />i'UBL.IC WORKS PERMIT <br />Print or Type Only <br />�Q IN�.� <br />Applicanl <br />Describe Proposed Work <br />AdJress <br />Projec� AddreSs (if known) /0935 — 3�� <br />Gty Zip <br />Attach lour (4) copi�s ol plans �or proposed work - Drew to scale and note Ihe follnwing as applicabl�. <br />• Property Lines <br />• Octline and dimensions of all existing and <br />proposed S�ructures on the lot <br />• Enisting and proposed utililies <br />PuOh�N'o�ksPn�m�ilp• y[._`.� `� /UZ <br />Die; Dent � �U_f(�_ <br />�� <br />Pvpl¢ Worb Fue -- <br />Totrl Fa9 $ <br />les: AOPL Fee Paid S <br />8aiance �ue $ _ Q � <br />• Centerline ot sireet <br />• Indicate North <br />• Show any proposed �rading changes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 2S9•8810. <br />2. All work shall be pertormed in accordancr with this permit and cwrent City oi Eveictt Des;�n and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-80p-424•5555. <br />`� I�vSrA!_C .E'i.v� �� Cou�� av�.e s�D6 S.�c%Fi��. C,��p.d-�x� <br />f �,� c.Ty s;,q,��,a,e,o .,�' !o os�. <br />S. Keep City streets clean at all times. <br />6. i;se pub].ic drainage system for roof-top down-spout. <br />7. Curb, gutter and sidewalk are new and unbrok .i. Any damage must be <br />replaced/repaired by the applicant. <br />8• l�iy changes to the drive�,ay curU-cut must be approved by the Public <br />Works Inspector. <br />' 'r /� <br />�.� �� ,� � �S <br />Approved�i�Or Construction Date <br />��- i�g`��%1 >�"� <br />�INAL INSPECTION Dale <br />Approved as Conslructed �� <br />everete PU6LICWORKSDEPARiMENT <br />� 3200 Cedar S�reet <br />Evemtt, VJA gB201 <br />Phone.259�NE10 <br />ACKNOWLEDGCAfENT OF CONDITIONS <br />W <br />r <br />�w <br />_/ <br />r <br />� <br />� <br />�J <br />� <br />� <br />O <br />a <br />The undersignad uwner/applicant hereby aprees to held,.ntl save hann- <br />less the City of Everett from any anL all claims lor damages, cost,, <br />expenses, or causes of action that may arise '.ecause of installation <br />and maintenance ot tlie improvement or o!her righ��ol��vay use hereto <br />applied for anC lurther agrees to remove same upon ootice Irom Ihe <br />�Cily an to replace public property damaged thereby. <br />�a �l 3 s' S S <br />Siynature ol Applicant � Date <br />WORK AUTI�ORIZED BY THIS PERMIT MUST BE STARTE� WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THERCAFTu� IS TO <br />BE DILIGENTLY PURSUE� TO C01.1PLETION. THIS PFNMIT tiIAY BE <br />CANCELLED BY THE CITY UPON �NY STOPPAGE OF WOfiK ON THIS <br />PROJECT OVER 90 UAYS DURATION. <br />/ <br />