Laserfiche WebLink
Date �"� � `"�"�> � <br />Applicatior �or <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />����.2L� <br />Mailing Address <br />Describe Proposed Work <br />City <br />� <br />P�bllc Wods Perm�t v � G�� <br />'' � ` isS`� <br />eiae. oaoi. • <br />Pu�litWo�ksfea S <br />To�al Fee <br />less AOPI. Fee PaiO s��j--�-- <br />Balanca Uua s �- <br />Zip Phone <br />ProjectAddress(if known) ����`�` 1 '�� fy���l�� r, � <br />Attach four (4) copies of plans lor proposed work • Draw lo scale and no�e ihe following as a�plicable: <br />� Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the Iot <br />• Ezisting and proposed utilities <br />• Centerline ol streel <br />• Indicate Nu�h <br />• Show any proposed grading changes <br />• Show measuremenls <br />PERMIT CONDITIONS <br />1. All calls Icr inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City ot Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 i��:c belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />,.S� � - i�ln,eK To F�E' ,C� �,d� <br />( / G: <br />l�PTEi> >-9-�5-, 7 <br />'������ 9 .7'> <br />Approved tor Const�Jon . Date <br />/>✓�`�'/ �/-�� <br />FINAL IN PE TION Date <br />Approved as Consiructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 CeAar Streel <br />Everett, WA 98201 <br />Phone: 259-8815 <br />/�F�' ,�Ps?.'l'vEO f�lf'�/ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />The undersigned owner/applicanl hereby agrees to hold a� ' save harm- <br />less the City of Everett irom any and all claims for damages, costs, <br />expenses, or causes of ac�ion Ihat may arise because ot installation <br />and maintenance ot the improvement or other righPOFway use hereto <br />�applied �or and furiher agrees to remove same uF'-+n notice hom ihe <br />City and to replace public property da aged lherehy. <br />/�i ,�/ <br />, <br />\�'_ ;1�,.�-� ��/i��l ' ^!r �ti,--C"-"- � ' T 1r'°/ <br />Signalure ol Applicant � <br />WORK AUTHORI2ED BY TNIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />I BE DIUGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />�� CANCELLED BY THE CITY UPON ANY STOPPAGE OF\YORK ON THIS <br />I PROJECT OVER 90 DAYS DURATION. <br />