Laserfiche WebLink
.. <br />��� <br />Public W°nu P@fdA <br />* y <br />Dwee�! <br />/ <br />AnUl�cahcn_For <br />BiCO. Debi. A <br />PUBLIC <br />WORKS PERMIT <br />P°°Townie°Fee <br />c al Works <br />- - <br />S <br />.T <br />U <br />Less Aber Fee Paid S <br />5 <br />Print or Type Only <br />O C.,CDBalance <br />r o <br />Due <br />es W <br />Owner Maduf$AT7 ss_ .. City Zip <br />8 -Li <br />Phone <br />�� F sip riri� <br />A <br />Applicant Mailing Address Clty Zip Phone <br />Project Address lit known) 331?1- <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 his in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424-5555. <br />Approved for Constru ion Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />ca <br />0 <br />n <br />z <br />0 <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs. <br />expenses. or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-ol•way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public or xty damaged thereby. <br />JS,.Wr IApphcan Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />