Laserfiche WebLink
Date—�—�� <br />Application For <br />PUBLIC WO�RKS PERMI� <br />Print or Type Only <br />PuDlic Wo�ks Pe �m�l • <br />eiea.oeo�.s ''�Y�.3 � � <br />Pu01ic Worka Fae s —_ <br />Total Fee <br />Le.s AO�� Fee Paid S�— <br />BalancaDue � <br />Describe Proposed Work �+�=` �� C� � S�� <br />-- � � �'� — �'�1,� � �r i <br />Prolect Addrese (il known) <br />Attach four (4) copies of plans for proposed work <br />Draw to scale and note lhe following as applicabl�-: <br />• Property Linea <br />• Outline and dimensions of all existing and <br />proposed structures on lhe lot <br />• Existiny and proposed utilities <br />• Centerline of street <br />• Indicate North <br />• SF.ow any Proposed grading changes <br />• Show measurements <br />PERMIT COND!TIONS <br />1. All calls for inspeclion shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shell be performed in accordance with this permit and current City of Everett Design end Gonstruction <br />Standards and �pecificalions. <br />3. Call Localion Underground Service 48 hrs. betore you dig. TOLL FREF. NUMBER 1•800•424-5555. <br />tof Cons�ruClioo <br />FINAL INSPECTION <br />Approved as ConsCructed <br />everett PUBLIC WORKS DEPARTMEN7 <br />� 3200 Cedar Streel <br />Everetl, WA 98201 <br />Phone: 25J-881 5 <br />ti� <br />Q'� e �I ��e'� <br />� �G� .b � <br />' � y2 <br />�� <br />Date <br />Date <br />� <br />0 <br />ACKNOWLEDGEMENT Of CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everetl from any anu all clair�s for damages, cosis, <br />expenses, or causes of action 'diat may arise because of installation <br />and maintenance of lhe improvement or other right-ohway use hereto <br />applied for and further a�rees to remove sa�ne upon notice irom the <br />City and lo replace public property Aamaged thereby. <br />Signature of Applic�nt <br />WORK AUTFiORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSI�ED AND THEREAFTER IS TO <br />8E DILIGENTLY PURSUED TO COMF�ETION. TH13 PERMIT MAY BE <br />CANCELLED BY THE GITY UPON ANY STOPPAGE OF WOfiK ON TIiIS <br />PROJECT OVER 50 DAYS DURHTION. <br />� <br />t7 <br />