Laserfiche WebLink
Uate - 30 97 <br />Application For <br />P�JBLIC WORKS PERMIT <br />Print or Ty �e Only <br />S% <br />ST <br />City <br />� <br />Public WorksPermll s _ �`' � r �� <br />BIEp. D2P1. t <br />�ubiiG Works Fee s <br />Tolal Feo <br />Less APPL Fee Paid S <br />Balance Dun <br />s �df-'= <br />Y8•zo3 <br />-3 <br />pp� Mailing Address City' 7_ip Phone �,.N�,��T- <br />MARf���w� .7fd-�.7iS1 <br />pc;cribe Proposed Work �1 �u � DS <br />Prolect Address (if known! ���� �V` � <br />Attach four (4) copies o1 plans lor D�oposed work • Draw to scale and note the following as applicable: <br />• Proper!y Lines <br />• Outline and dimensions of all existing and <br />proposed structu�as on the lot <br />• Existing and proposed utiiities � <br />• Centerline of stree� <br />• Indicate North <br />• Show any proposed grading changes <br />• Snow measurements <br />PERMIT CONDITIONS <br />1. All ca�ls br inspection shall be made 24 hrs. in ad•:ance • phone 259•8815. <br />2. All wcrk shall be performed in accordance with this permit and currznt City 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•424•5555. <br />7`, �E� .iT.fEETS �'.c c.?�✓, <br />�y.C� �O'Jf't� ���� <br />Approved for Construction �' ate <br />�" y�- <br />FINALINSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone:259•8815 <br />Q2/04i87 5�36PM <br />u000s.�ssb <br />C�FuT�e.2�,0� 55�0t1.t010 <br />ACKNOWLEDGEItl1ENT OF c61Vi71QIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />The undersigned owr�er/applicant hereby agrees to hold and save harm- <br />less the City of Ew��=it Irom any and all claims for damages. costs, <br />ezpenses, or causc: of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and lurther agrees to remoae same upon notice trom ihe <br />Ciry and to replace public property damaged thereby. <br />icant <br />Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE ST.4RTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO CGMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPOIJ ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURPTION. <br />