Laserfiche WebLink
Dare�3/3•'!��-r/ <br />Applicatioii For <br />PUBLIC WVORKS PERMIT <br />Print or Type Only <br />Pu�Lc Works Permit ♦ u�u� <br />eiae. oer�.• � <br />PubOCWorMSFee s <br />To1al Fxe <br />lass AOaG Fee PaiE $ <br />BalanteDue S LQp� <br />n��u�anr Mailing Address City Zip rnone <br />Prolect Address (if known) � ✓ {L � �[ ! -fi^ - � ��� — <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the tollowing as applica;ile: <br />• Property �ines <br />• Outline and dimensions of all existing and <br />pioposed shuctures on the lot <br />• Existing and proposed utilities <br />n� <br />fV <br />• Centerline of streel <br />• Indicate North <br />• Show any proposed grading chanyes <br />• Show measuremrnts <br />PE.4MIT CONDITIONS <br />;. qll cails for inspection shall be made 24 hrs. in advznce • phone 2�i9•887 5. <br />2. All work siiall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standarifs and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />������ y 3 �s� <br />Approved for onstruction Dste <br />�fl .�/�-�j <br />FI AL INSPECTION Date <br />Approved as Cunstructed <br />evere[[ PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. P.A 98201 <br />Phone: 259•8815 a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />The undersigned owner; applicant hereby agrees to hold and save harm• <br />less the City of Everett !mm zny and all daims for damages, costs, <br />expenses. or causes of au-on that may arise because ot installation <br />and mainter.nnce of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice irnm the <br />Cily and t eplace public property damaged thereby. <br />ignature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERM�T �'UST BE STARTED WITHIN <br />180 DAYS OF D.4TE PEFMIT IS ISSIIED �ND THEREAFTEfl IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY' BE <br />CA��CELLED BY THE CITY UPON AN`.' STOPPAGE OF WORK ON THIS <br />PROJECT CVER 90 DAYS DURATION. <br />