Laserfiche WebLink
Date���0 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print �r Type Only <br />Ci�y Zip <br />Zip <br />Descritr.; Proposed Work <br />Pioject Address (if known) <br />PUELc Works Permit a ��_�� O <br />BIOg. Cept + �� �/�A� <br />PueLc Works Fen ^ <br />Totai Fc^_ s <br />Less noo�. Fce Paid S_ <br />9alance Due .S �� �, <br />,�ttach four (4) copies of plans for proposed work - Draw to scale and notr the following as applicable: <br />� Property Lines • Cenierline ot .trcet <br />• Outline and djmensions of all existing and • Indica:e North <br />proposed structures onthelot • Show any proposed grading changes <br />• Existing and proposed utilities • Sho�� measvrements <br />PERMIT CONDITIONS <br />1. All calls'or inspection shall be rr,ade 24 hrs. in ativance - phor.e 259•881 5. <br />2. All work shall be yerformed in acwrdance with this permit and wrrent City of Everett Design and Cons:ructwn <br />Sinndar[Js and Specifications. <br />3. Cal; Location Undergrourd Service 48 hrs. before you dig. TOLL FREE NUMBER 1-$00-424•5555. <br />�� <br />� <br />�'�/ i, 7 r 7 <br />�-11�2%�i L-�ic%: i� - / '� <br />Approved for C nstruction /�� �" Date <br />/> Ci-/%.. <br />. --� <br />%i i•�-"" :�;�, ��" 7 /'� �� <br />FI INSPECTION Date� <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200CedarSireet <br />Everett, WA 98201 <br />Phone: 259-8815 <br />ACKPlOWLEDGEMENT OF :iG.'JDITIONS <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ownerlappiicant hereby a;vees to hold and save harm- <br />less the Ciry of Evr.rett '�-•�- any and ail claims for asmages, cosls, <br />expEnses, or causes of ar.t�.an that may arise because of installation <br />and maintenance of the .mprc-�ement or other right-ot��roay use herrto <br />applied for and further agrees to remove same upon r.utice from the <br />City and eplace public property damaged thereby. <br />( .� Q --5-8� <br />Sign ure of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFT�R IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEF 90 G,4YS DURATION. <br />