Laserfiche WebLink
Datell,J�4Z� <br />� <br />qppGcation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br />Describe Proposetl Work <br />Cny <br />o„n�,�.vnr�.n��U 1. ��' �/+�'� <br />u�nq oen� • . �1-C?�J�' <br />Pu�M1c Wons Fee s ---�—�--' <br />io;ai Fee <br />Less Ap01 Fee Paia S — <br />QPIpfICB �JB S <br />Zip <br />Zip Phone <br />Project Address lif known) —�f/ %�`t� l.L�r ^ 1 /-J�`�— <br />Atlach lour 14) coples ot plans lor proposed work - Drew to sca�e and nole the tollowing as apPlicahle: <br />• Property Lines <br />• Outline and dimensions oi all ezisting and <br />proposetl sirudures on the lot <br />• Existing and proposed utilities <br />• Centerline of s,�eet <br />• Inditale Norih <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor i��ispection shall be made 24 hrs. in advance • phone 259•8870. <br />2. All work shall be pedormed in acwrdance with this permit and current City or Everett Oesign and Construction <br />Slandards end Speci!ications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUNRER 1•B0�•424•5555. <br />� � 1��1�-1 ��z.n�l �-t- �-cQ <br />i�ce,�-�- VV1 `-�eQ- <br />Approved lor Consiruc�ion Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 98201 <br />Plione: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />1 �L`e� <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The undersiyned owner/applicant hereby agrees to hold and save harm- <br />less the Ciry of Everelt from any and all r,!aims lor damages. costs, <br />expenses, or causes of action ihat may arise because of installation <br />and mamtenance of Ihe imprcvemenl or other ri�hPol-way use herelo <br />applied lor and lunher agrees lo remove same upon notice irom the <br />Cily and to replace public pronerty damaged lhereby. <br />Signatwe ol ApPhcant vaie <br />WnRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1ti� 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 ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />