Laserfiche WebLink
Date �Y�J�� <br />� � <br />Application For <br />PUBL9C: WORKS PERPJIIT <br />Print or Type Only <br />rnainn9 <br />A ddress <br />Cil)' Zip <br />Pu01ic Works Perm�l r ���/ <br />Blap. pepL � � � 'r <br />Publit Works Frte <br />To�el Fee 5 ___ <br />loss ApOL Fee Pald � . <br />Balanca Dua $ �� <br />S3 " Y7 <br />Phonc <br />Phone <br />Drocribe Proposed Work _�► ��a1 YPS, i/�i �1�Q�_�_ lo+f �// C pljyi- %���,d�� �„� ,(� � <br />�-�L� <br />Project Address (it known) <br />Attach tour (4) copies of plans �or proposed work • Oraw to scale and note the following as applicable: <br />• Property Lines • Centerlir.e ot strect <br />• Outline and dimensions of all existing and • Indicate Norih <br />. proposed siructures on ihe lot • Show any proposed gradinc� changes <br />• Existing and proposed utilities • Show measurements <br />IGI <br />PERMITCONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and wrrent Ciry of Everett Design and Construction <br />Standards and Specifications. <br />3. Call location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-Q24•5555. <br />�� <br />r <br />�'��� � /s� 8B <br />ApproveU tor Co st ction �-, Date <br />' //// <br />C� � �1 -� S <br />FINA INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WOHKS DEPARTMENT <br />� 3200 CedarSireel <br />Everett, WA 98207 <br />Phor,c..25g-BB10 <br />ACKNOWLEDGEMENT OF CONUITIONS <br />W <br />� <br />si <br />� <br />� <br />� <br />0 <br />a <br />The undersi9ned owneUapplicant hereby agrees to hold and save harm- <br />less the City of Everett Irom any and all claims for damages, costs, <br />expenses, or causes of action that may a�ise because of instadation <br />and maintenance ol the improvement or other righhof-way use h ereto <br />appl�ed lor and lur:her agrees to remove same upon notice Iran ihe <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />160 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />RE DILIGENTLY PURSUED TO COMPLETION. iHIS PERMI7 MAY BE <br />CANCELLED 8Y Tl1E CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATIUN. <br />