Laserfiche WebLink
Date.�29 -9z <br />Application For <br />PUBLIC WORKS PERMIT <br />Print ur Type Only <br />� <br />\V <br />:� <br />PUEIic Work! Permlt s /'� LV � <br />BItlB� DapL • <br />Pu011c Works Fee <br />Totel Fea S <br />Leaa AOG� Fae PeiO S <br />Balance Due $ � 3�� <br />� Appiicant Mailiny Address City Zip Phone <br />Desciibe Proposed Wark <br />Project Address (if know�) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the fol�owing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />�92-I <br />• Centerline of street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measwements <br />PERMIT CONDITIONS <br />� 1. All calle for inapection sheli be made 24 hrs. in advance - phone 259•8810. <br />� 2. All work ahall be peRormed in accardance with this permit and wrrent City ot Everett Design and Conatruction <br />�� Standerds end Speci(Icetiona <br />� 3. Call location Unde round Service 48 hrs before you dig. TOLL FHEE NUMBER 1•800�424•5555. <br />! 1. Applicant shoul� shedule a meeting with Dennis Gableman (339-7403) <br />! to discuas fill site_ <br />i 2. Install a rock construction entrance as per atd. plan #208. <br />3_ No dirt ahall be hauled in unti.l all erosion controls are in place <br />and inspected by a Public Works Inspector. <br />4. Adhere to temporary ero�ion control notes in sect. � of the City cf <br />Everett Design and Conatruction Standarde. <br />�L.1,4.1 <br />.� � S �`3z �'� # 9z- iz <br />oUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Evarett WA 98201 <br />Phone:259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The undersi9ned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett tro:n any and all claims for damages, costs, <br />expenses, or causes 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 furiher agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />r `� �%Z/LZ <br />Sign ure of Applicant Date <br />WORK AUTHOflIZED 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 8E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATiON. <br />