Laserfiche WebLink
r <br />Date� <br />qpplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />aS�20 -�l�r N� � n �e .Sy <br />Malling Atldress C�ty Zip <br />Mail�� ress Citv Zip <br />n r . � .i <br />Describe Pwposed Work <br />_ - � q. /� , � . �_i <br />PUDbc Works Perm�t � _l � � � <br />eiap Depi.. .�� - <br />PubOCWorvsfee s <br />TO�A1 F�! <br />less Anol. iee Px�tl S� <br />e.ia��eo�o f Z <br />Prolect Address lif known) � — ' - <br />AttaCh four (4) cooies of plens for proposed work - Draw to scale and note ihe lollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />prOposed structures on ihe Iot • Show any proposed gradin9 changes <br />• EKisting and proposed utilities • Show measurements <br />3.�'�-QU.3�' <br />PERMIT GONDITIONS <br />1. All cells for inspection shell be mede 24 hrs. in advance • phone 259-881 O. <br />2. All work shell be peAormed in accordance with Ihis permit and current Cfty ot Everetl Design end Construction <br />Standarda end Specificationa <br />3. Cell Lxetion Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1-800�424-5555. <br />�• Zf�N�IJ(a C'��� L1nn �TS 02��/� I�IhY 1..! � p��y 'i� <br />ZG' ►�-t �-Rt�NTN� 2�' F2�a.t'r ��c—Tr3A�-K. <br />� G t-c Y s~rr�s s N-nu., ac- �-r�t � c-.-� r�-r A�.i �-n n�c <br />(s � G�^�a C v�rr�"�. a�.N:� ���c i.�a��K �v,� N�J M.�r� �� e3�T� <br />ri�7� 7A*�kG�E SH�1t.l. Br Y-CI�I.Au.v GY' iNv= AISR-��n� <br />FINAL INSPEc1�Urv <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt. WA 98201 <br />Phone:259-8810 <br />�Z�— <br />Date <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant herehy agrees to hold and save harm� <br />less the City ul [verett Irom any and all claims for damages, costs, <br />ezpenses, or causes ol action �hat may arise because of installation <br />and main�enance of the improvement or other riyht-ohway use hereto <br />applied lor and further agrees to remove same upon notice Irom the <br />Cit and t replace pu ic perly damaged ihereby. <br />2 /3 U <br />Signalure of pPlic Date <br />80RDAYSTOF DATE PERMIT ISESSUED AND THEREAFTER ISHTO <br />BE DILIGENTLY PURSUED TO CUMPLETION. THIS PERMIT MAY BE <br />CANCELLED 6Y TNF GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />� <br />