Laserfiche WebLink
Date� "��` J� <br />qpplitotion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />��,���g� �-39z <br />r�ei,�wo��sae�m��! �7 <br />s.z <br />nme o�oi • —L� <br />r�ne�� wo�se rea S <br />Totnl fae <br />lela Ppnl. foe Ve�tl s �� <br />Balancn �un s <br />�• <br />c,�y z,n anone <br />Applicant <br />Idailing AdAre55 C1Iy Zip Phone <br />Deacribe Proposed Work ���` '�� <br />Prolect AdCress lif hnown) <br />Attech four (41 copies o� plans for aroUosetl w�ork - Draw to scale and note Ihe following as applicable: <br />• Property Lines <br />• Outline a�d dimensions of all existing and <br />proposed structures on the lot <br />• Ex;ating and proposed utilities <br />• Centerline ol sireel <br />• Indicate North <br />• Show any pronosed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be mede 24 hrs. in advance � pt�one 259•8810. <br />2. All work shall 6e pedormed in accordance with this permit end wrreN Ciry of Everett Design and ConsVuction <br />Standardn and Specifications. <br />3. Call Locetion Underground Service 48 hrs. belore you dig.7�OL� FREE NUMBER 1•BOQ•424-5555. <br />Approvedfor <br />� <br />Approved as Gonstruaea <br />everelt PUBLIGWOFKSDEPARTMENT <br />� 3200 Ceda� Street <br />Everett, WA 98201 <br />Phone.259-8810 <br />� <br />AGKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />ihe undersigned ownedapplicant hereby agrees to hold asd save harm- <br />less ihe City ol Everett Irom any and all claims for damages, costs, <br />eapenses, or causes ol action Ihat may arise because of installation <br />and ma�ntenance ol the improvument or other right�ol-way use hereto <br />applied lor and lurther agrces to rem�a9ed herebyn notice trom the <br />City an�.lq replace pubhc prope�y� <br />Date ' Date <br />gnature ol p iQ nt <br />BORUA STOFRDATED P[RMIT ISEISSUED AND THEREAFTER ISHTO <br />BE DILIGENiLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />