Laserfiche WebLink
Da�e ' �_• <br />Applicaimn For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />1����� ,�>�(�(,l'I i`i � <br />oW��� <br />7� �� l I (� <br />�pplicant <br />Mailing AAdress <br />, � � J( �T <br />Describe Proposed Work � � ` � � / <br />, <br />Prolect Address (if known) <br />� ... .:..... ..... �, , . ,- - -. <br />_ �i r <br />mn� n�.��i . �_-J—i�---`-1--_ _ <br />Fubi�cWa�As(eo �, <br />tolal ico <br />Lmf nppl Fee �'e�G 5 <br />Pq100LOU110 g <br />;"� i���'� ,���`���.�- �,' (�-; <br />City Zip <br />AOach lour (4) copies ol plans lor propo5ed work - Draw lo scale and nole �he lollowing as applicable: <br />• Property Lines • Centerline ol stree� <br />• Outline and dimensions of all existiny and • Ini�cale Norih <br />proposed structures on the lol • Show any proposed gradiny chanc�es <br />• Existing and proposed utililies O Si�ow measuremeMs <br />E <br />PERMIi CONDITIONS <br />1. HII calls lor inspeclion shall be made 24 hrs. in sdvance - phona 259•881 5. <br />2. All work shall be perlormed io accordance with Ihis permit and current City ol Everell Desi9n and Construction <br />Standards and Specilications. <br />3. Call Locntion Underground Service 4B hrs. be�ore you dig. TOLL FREE NUMBER 1-800-424•5555. <br />i �Ti i���. �%%��- r' � '� p i � <br />� � � <br />�� !4'�'�,c��n" /�/.�T if�1t"i� <br />��/zeja � <br />Approved lor Construction Date <br />FWAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Strect <br />Everett. WA 982G1 <br />Phone:253��015 <br />� <br />,� <br />W <br />H <br />� <br />� <br />� <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owneri applicant hereby agrees to hold and save hacm• <br />less Ne Cily ol Everet� Irom any and all claims lor damagns, cosis, <br />expenses, o� causes ol action iha� may 2rise because ol installa�ion <br />and mamtenance ol the improvement or other righbof-way use hereto <br />applied for and lurther a9rees to remove same upon nolice irom �he <br />Cily and to replacr. pubtic property :;amac�ed �hereby. <br />Date Date <br />Signature ol Appliwnt <br />WnRK AUTIiORIZED BY THIS f'ERMIT MUST B[ STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSU[0 AND THEREAFTER iS TO <br />8E DIIIGENTLY f'!I�SUED TO COMPLETION. 11115 PERMIT MAY BE <br />ICANC[LLED OY TF{� CIiY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJ[CT OVGR 90 UAYS DUHTTION. <br />� <br />