Laserfiche WebLink
. , / ' <br /> / <br /> Date I � T�• � /r� — <br /> —+— �"� �uhlir,YlorkSPermllc �� <br /> Eltl .OePt+�� / .� ) � 1 1 <br /> Application For e <br /> PUBLIC WORKS PERMIT P����=W��ks�,� — <br /> Total Fec $ <br /> LessAppi FeePaltl $ <br /> Print or Type Only e`","`:'.o°` $ `-`"��— _ <br /> , <br /> c— t i• �� - r c� � - <br /> ;�'-�.�Y'�`� , ^,�z-`,> ✓�" /`�X In, J�)"/.!��_ 1 � ��� `�%`'��I> ����7- �>/��� 'I <br /> Owner Mading Address City Zip Phone �� <br /> !t �1 <br /> Applicant Mailinc�Address City Zip Phone ' <br /> Describe ProPosed Work 1 ��1� i .����� � �J� � � _� (!'•��� ��� d ?`��'� � �'��'-"� �� �- . <br /> �----r?�' <br /> C; )� 1 ; � �-� <br /> i'rojecl Address 1if knownl 1 U �' � '� ����� ��—f'`�-'� S�� � �I <br /> Attach four(4)copies ol plans lor proposed work- D:aw to scale and note the following as applicable: � <br /> � Property Lines • Centerline ot street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> propo5ed sVuctures on the lot • Show any proposetl grading changes <br /> • Exisling and proposed ulilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permil and cu«ent Ciry of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> 4 .ANY CHANGE IN THL+ DRIVEWAY CUT MUST BE APPROVED O <br /> BY THE PUBLIC WORKS INSPECTOR. <br /> 5 .CONNHCT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. <br /> 6 .REEP CITY STREETS CLEAN AT ALL TIMHS. � <br /> 7 .ANY DAMAGS TO THE CURB AND SIDEWALR WILL BE REPAIRED � <br /> TO THE SATISFACTION OF THE PUBLIC WORRS DEPT. <br /> O <br /> a <br /> ,�11„ ACKNOWLEDGEMENT OF CONDITIONS . <br /> ��% The undersigned owner/applicant here6y agrees to hold and save harm� <br /> less the Gity of Everett irom any and 211 claims for damages, costs. <br /> expenses. or causes of action Ihat may arise because ot installation <br /> �� ,,, l �G[i�� L/ � �C�U and maintenance of the improvement or o�her righ��of-way use herelo <br /> P applied lor antl further agrees to remove same upon notice irom the <br /> Approved for Construr,tion Date Ciry and to replace public properry damaged thereby. <br /> Cc1-l'�''�� �/'�_ �o /�� /� / <br /> FINAL INSPECTION Date �«�c�, ( A/� .3 �.Z`�'� <br /> Approved as Constructed Signature of Appli ant Date <br /> everett PUBLICWORKSDEPpRTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAR��ED WITHIN <br /> � 3200CedarSueet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERD.IIT MAY 8E <br /> Phone:259�8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORY.C�N THIS <br /> PROJECT OVEF 90 DAYS DURATION. <br /> i <br />