Laserfiche WebLink
Date1��, <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />P�blic Worb Permil • `� b— G�`� <br />niep Deoi� • <br />Publ¢ Works Fee <br />TodlFne S <br />Leaa Appl fee PeiA S <br />BnianceDue S ���0 <br />J�na/� .G. im�9�Z .3�t- �VE iya""' �.�.� ��>�.. 9�jcs ' Yis�yy� <br />Owner Mailing Address Cily Z�p Phone <br />Mailing Address <br />Describe Proposed Work <br />Pr-; �- :t Address f if known) <br />AB.. ,i four (4) copies of plans for proposed work • Draw to scale and note the lollowing as applicable: <br />• Propeity Lines <br />• Outline and dimensions ot all ezisting and <br />proposed structures on the wt <br />• I:zisting and proposed u�ilities <br />• Centedine ol street <br />• Indicate No�th <br />• Show any �roposed grading changes <br />• Show measurements <br />Phone <br />PERM�T CONDITIONS <br />1. All c�lls lor inspection shall be made 24 hrs. in advance � phone 259•881 5. <br />2. All work shall he performed in accordance with this permit and current City cf Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER �•800•424•5555. <br />� % �E�a[�E � �EPL.S'CE E�C/Siiid(s CG.t=B� Gy/T7E�C <br />ANv ,J'iVEc�19C,C , 1NSi 9LL v,�/dcliJ9� /�E.�'. C/iJ/ <br />srH.�/o9.eo �so7. <br />E'K.sr,tiU cvti�a �s ,VoT .-c aF k,✓��.cEo �Ff. <br />SEE FI rTyCHFO NOT£ <br />���'r��'�o� 7 �/a6 <br />Approved for o iructi Dale <br />��!/ j� :.?/-d % <br />FIAAL INSPECTION ate <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 9d201 <br />Phone: 259�887 5 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />The undersignetl owner/applicant hereby agrees to hold and save harm- <br />less the Clry ot Everett Irom any and all claim; loi damages. costs. <br />expenses, or causes ol aclion Ihat may arise because o� installalion <br />and maintenance of Ihe improvement or other ri�jhPobway use herelo <br />applied lor and Iwther agrees �o remove same uuon noBr.e t�om the <br />City and to replace public property damaged ihereby. <br />ignature ol Applicant � '��� pa'e <br />WORK AUTHORIZED BY THIS PERMIT MU.�'iT BE STARTED WITHIN <br />180 DAYS OF DATE PEFMIT 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 />