Laserfiche WebLink
�ace ��YL <br />Application For <br />PU�LIC WOfiKS PERMIT <br />Print or Type Onl � $ g <br />� � � _ � <br />Owner <br />�� <br />ai <br />O U <br />Address <br />City <br />P�Clic Worlu Fn' a <br />Totel Fee <br />Lese AppL Fn PeiC S /�� <br />ga�ance [lua S � <br />Phone <br />.:� . / � ' = — ---�--�' u .' . <br />ocs�� �� �.nrn n � iv_ <br />Proiect Address (it known) + <br />Attach four (4) copies of plans for aroposed work • Draw to scale and note the tollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimen•sions of all existing and • Indicate NoAh <br />proposed stNcturas on the lot • Show any proposed grading chenges <br />� Existing and proposed utilities • Show measurements <br />PEFMIT CONDITIONS <br />7. All calls for Inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work ahell be performed in accordence with this permit and current Ciry of Everett Deaign and Construction <br />Standerds end Speciticetions. <br />3. Call Lxation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•SOo-4245555. <br />�. ��os'�on Gon4.fo1 shall be P�ov;� as Pc� thc P�an ouF,l:ntd ;n�pu�' (etZc� <br />�o �,hcc�ty dabed Novcf^bcr3o,i�►9L. �n add�t;on, a5;�{cn�c perstandar�a <br />� Plan � ZoS�. al. u,a sayc of't,hc 35 �ot- b�'s � a�wto thc ez �st� h q wat �and. <br />,vwstbc �asta�led• ��� eru57on control r*�eas�res shn�� bc ��'+st.��ledetFJtG <br />d;�tct:�onaf thc P�bit�\Vor�s Inspe�.t,or <br />5. �Y:�h�n 30 days o� ihc �s.ueo4 th�> �e.rr+t:t, Busc'f'�w�bcr a+ustmeat �vttl� <br />the G�u'at.t f�ft Ddpartwl�rK-eY►d �eso�ve �+e 5 ss•aGs Ce1at-��q t� tha 4.+e1 <br />ybo�a e�nrs on t1+c sit�- `l�/er K do„G o�� t MG-F!� �t+a� 0 5"a.�d w�� f r•1 <br />yo siik.zon �F.7.5 o�F t�� �;�'ys �aHdpl�t AMd 4pGG� <br />fe�uire a s�(�Lr� P�V����Vorks F1e✓m�tr. <br />6. G;� �cats m�ct (X ►�� ���r of d'rt and dcb�^;s atail t'.maS. <br />�� <br />A ved for Constry ion Date <br />� <br />FINAL INSPECTION Date <br />Appro�•ed as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar S�reet <br />Everetl, WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDGEME'JT OF CONDITIONS <br />The undsraigned owner/epplicant ��ereby agrees ta hold and save herm• <br />less the City of Everett from an�� and all claims for damages, costs, <br />expenses, or causes of action that may arise because af �installation <br />and meintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove seme upon notice from the <br />City and to replace pubiic property damaged thereby. <br />U!«c�/,�it�iF � `� y� — <br />Signature of Applfca Dete <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 PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAOE OF WORK ON THI3 <br />PROJECT OVER 90 DAVS DURATION. <br />