Laserfiche WebLink
Date_LLLL1 t� u <br />qpplicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />Mailing <br />iling <br />j--7 i/� <br />Descrlbe Proposed Work � l.1-�� <br />. <br />Pwlea Adtlress �il knownl <br />cuy <br />Zm <br />Altach low (A) coples ol plans tor proposed work � Draw to scale and notr. ihe following as applicable: <br />• Properly Lines <br />• Outlme and dimensions ol all existing and <br />prop05ed Slructures on Ihe lot <br />• Ezisting and propo5ed utilities <br />Cu1�liC 1YOik5 P�rrt',il IJ <br />B�n9 U��N.. �I�I� — . <br />" � <br />Publ¢ WoiFs ieo <br />Tolal Fec $ <br />LrsS Nppl Fec Pdid S <br />polance Duc <br />• Centerline ol street <br />• Indicate North <br />• Show any nroposed grading ch2n�es <br />• Show measurements <br />LI <br />Phone <br />��� <br />PERMIT CONDITIONS <br />1. All calls lor inspeclion shall be made 24 hrs. in advance - phone 259•SBi 0. <br />2. All work shall be pertormed in accordance wlth �his permit and curnant Ciry ol Everet� Design and Consiruc�ion <br />Standards and Specilications. <br />3. Call Location Undergroucd Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />��.�� �.��%. a�,,n�.� ,�� ,<{��� .��� <br />Approved lor Construction <br />FWAL INSPECTION <br />Approved as Construded <br />everetl PUBLIG WORKS DEPARTMENT <br />� 3200CedarStreet <br />Evcretl, WA 98201 <br />Phonc:259�8810 <br />Date <br />Date <br />� � -�� �,� <br />�CKNOWLEDG[MENT OF COIJDITIONS <br />Z� <br />O'�� <br />H <br />� <br />O <br />2 <br />The undersigncd owner/appliCart hereby agrees to hold and save harm� <br />less the City of Everetl Irom any and all claims lor damages. costs. <br />expenses, or causes of action that may arise L+ecause ol installation <br />and maintenance ol the improvemenl or other rigM-ol-way use hereto <br />applied tor and lurther agrees to remove same upon notice Oom the <br />City and to replace puUlic property damaged thereby. <br />Signature ol Applieant Date <br />WORK AUTI10R12ED 8Y THIS PERMIT MUST BE STARTED WI7NIN <br />180 DAVS OF DATE_ PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT tdAV �[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF \:�ORK ON THIS <br />PROJECT OVER 90 DAYS �URATION. <br />