Laserfiche WebLink
Date��y(,}a' <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />N4 � <br />mmm�g nuaress <br />cny <br />Describe Proposed Work n f� lD �ftNi I Q/�r��'�'� bH��n%I'1G <br />ProiectAdtlresslilknownl /S3�— <br />Attach lour �4) copies of plans lor proposed work • Draw to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions ol all :,cisting and <br />proposed structures on ihe lot <br />• Existinp and proposed utilities <br />itmer. woas vmmn . �`� � /" � <br />fliny Depl. � ��Qa� <br />PuM¢ Wo�he iea <br />Tomi von S <br />L�sf RpP� �ae PeiU s <br />Balnnco Oue .i �� <br />• Centerline ol slreet <br />• Indicate North <br />• Show any proposed yrading changes <br />• Snow measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calis for inspection shall be made 24 hrs. in advanre - phone 259•8810. <br />2. All work ahall be �oAormed in accordance with this permit and current City of Everect Design and Construction <br />Stendards and Specificatlons. <br />3. Call location Underground Service 48 hrs. before yau dig. TOLL FREE NUMBER 1•800-424•5555. <br />� ����� <br />,Qo� �� <br />� �� <br />s---�_8� . <br />� � S 2 8B <br />Approved lor Consf ction Date <br />� � ��� <br />FINAL INSPE TION Date <br />Aporoved as Constructed <br />everett PUBLIC WORKS DEPAHTMENT <br />� 3200CedarStieet <br />Everett, WA 98201 <br />Phone: 259�BB10 <br />W <br />� <br />� <br />� <br />� <br />H <br />� <br />O <br />OS/18/BB 9:36A1i OOOAM0642' �f <br />/ �� <br />N00097722 <br />FY FC ���6.�40p <br />ACKNOWLED(�L�r�[T OF (S'(�7,N(9yf�YlONS <br />The undersigned owner/applic�lS'Areby agrASS td hold and save harm• <br />less ihe Ci1y ol Everetl trom any and all claims lor damages, costs, <br />expenses or causes ol action that may arise because of installation <br />and maiMenance ol ;he improvement or other right�ohway use hereto <br />applieo lor and lurlher ac�rees to remove same upon noLce Irom ihe <br />City and to r ace pu^blic property damaged ihereby. <br />�%�. �' <br />,.���J �- .� _ <br />gnature ot Applicant Date <br />WORK AI;THORIZ[D BY THIS PERMIT M ST BE STAFTED WITHIN <br />180 DAYS Of� DAiE PFRMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSI ED TO CU�IPLETION. THIS PERMIT MAV BE <br />CANCELLEU BY THE CI fY UPON ANV STOf PAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATiON. <br />