Laserfiche WebLink
:�.App�itation For <br />PUBLIC VI�ORKS PERMIT <br />PUE3LIC�WORKS �EPARTMENT <br />3460 Cedar Sireet <br />Everctt, (�'!A 99201 259-8810 <br />r4.5 <br />Date <br />/z /qs- ' <br />Public Works Permit M ��� <br />Building Permit M <br />0 0 <br />TYPE OR PRINT ONLY � ""• Z,�"� <br />�n p � Public Works Fee $ <br />J (�� f•; <br />a� +a � <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />�� <br />Attach }our (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />�Property Lines 'Outline and dimensions of all existing and proposed struc�ures on the lot •Existing and pioposed utilitles <br />'Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig, TOLL FREE NUMBER 1-800-424-5555. <br />AS �. pl�� <br />� <br />� � — o� /T -iG <br />:� �OSTING L-��-44 <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and s:�ve harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of aclion that may arise becausa of installation and maintenance of <br />the improvement or other righaof-way use hereto applied for and further agrees <br />to remove same upon notice from Ihe City and to replace public property <br />damaged thereby. <br />FINAL INSPECTION Date / <br />ApPmved as Constructed ��� - /% / ��_ � <br />�-9 naWre ntT—' j� Date <br />WORK AUTHORIZED BY hIIS PERMIT MUST BE STARTED WIhiIN 180 DAYS Of DATE PERMIT IS ISSUED ANO THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PEFMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PR0.IECT OVEfl 90 DAYS DURA710N. <br />