Laserfiche WebLink
r,� PUUIm WO�ks Poimp • <br />Date�:J.�=� � meo oao� . ���� ---� <br />ppplication For <br />PUBLIC WORI(S PERMIT <br />Print or Type Only <br />ruer�c works Fea s <br />iolsl Poo <br />Len Apo� Poe Pnid s <br />ON�ROCE D�B 'S <br />/ ^ Cily Zip Phone <br />Applicant Mailing Address <br />Describe Proposed Work ,J `� � r"' '� r�� _ <br />Prolect Address (it known) ' <br />Attach lour �4) copies ul plans lor proposed work - Draw to scele and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Ezisting and proposed utilities <br />• Centedine of sireet <br />• Indic�te North <br />• Show any p�oPosed greding changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hra in advance - Fhone 259•881 5. <br />2. All work shali be perlormed In accordance with Ihis permit and current City of Everett Design and :onstruction <br />Stendartls end Specifications <br />3. Cell Locelion Underground Service 40 hrs. belore you dig. TOLL FREE NUMBER 1•800'424•55 . <br />y-«-B7 <br />�v5'��G' l-c�,�-1' �F��i; �` �P��9�,,�.v �/�� <br />`�I <br />Approved lor Construction <br />Date <br />Date <br />FINAL INSPECTION <br />qpproved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone�. 259�H8?S$QOU <br />7 <br />W <br />H <br />� <br />� <br />� <br />O <br />H <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Tne undersioned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett irom any and all claims tor damages, cosis. <br />expenses, or causes ot action that may arise because of in5taitation <br />and maintenance ot lhe improvement or olher righl•of•way use hereto <br />applied lor and turiher agreeoer�tyrdamaged hereby.n notice irom ihe <br />City and to replace public pro. <br />Date <br />Signaturc of ApplicaN <br />80RD YSTOFRDATE PERMIT ISESSUED AND THEREAFTER ISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />PROJECT OVER 90 DAYS DURATION. STOPPAGE OF WORK ON THIS <br />