Laserfiche WebLink
ogce�� G <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PuGIm Wo:hsPeimil • V �IU J <br />BIQB. DePI. s � �. <br />„�o��� we,k, F„a s <br />Tolal Fee <br />Less ApPI. Fee Paitl S <br />GQ ��-- <br />Palance Oue .i __ <br />Owner a K1ai4ing Address cy up rnone <br />�Applican� Mailing Adtlress City ZiP Phone <br />Describe ProposeC Work <br />Prolect Address (it known) _ <br />Attach four (4) copies of pla� � for proposed work • Draw to scale and note the ��oilowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of nll existing and • Ica�ra�e North <br />pr000sed stracNres on !he lot � Show any proposed grading changes <br />• Ex�sting and proposod utilities • Show measurements <br />�� <br />FERM�T CONDITIONS <br />I. All calts for insoection shall be made 24 hrs. in advance - pnone 259•881 5. <br />2. All work shall be pertorned in accordance with this permit and currant Ciry of Everett Uasign and Constructinn <br />Sta,:9ards and Sper,ifications. <br />i C::�I Location Underground Service 48 hrs. before you d�g. TO�L FREE NUMBER 1•S00•424•5555. <br />ZI�.� fJ�lh...7��� '�'� J' G�.l. <br />� <br />Ap�roved for Construction Da!e <br />� / <br />l ��_�� <br />FIN PECTiJN Da�e <br />Approved as Constrocted <br />everett PUF'JC WORKS DEPARTMEN7 <br />� 32r.0 Cedar Streat <br />Everett. WA 98201 <br />��'hone: 259-8615 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agreos to hold and save harm• <br />6=ss the City ol Everetl from any and all claims for damages, costs, <br />�xpen�es, or causes of action that may arise because of installation <br />and maintenance of the improvement or uther right•of•way use hereto <br />applied for and lurther agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature <br />Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS ?ERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />