Laserfiche WebLink
Date«'�'ZC7"FTl(o <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Worka Permit t� b <br />eiaa oeP�. s <br />PuElic Worke Fee —.s� <br />Total Fse s _ �dJ <br />Leee AOPI. Fee PeiE S_.�� <br />BaianceDue S ��� <br />Owner MaiNngAUdress City Zip Phone <br />Zip <br />Describe Proposed Work <br />Project Address (if known) <br />Atlach four (4) copies of plans tor proposed work - Draw to scaie and note the fo�lowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of ail axisting and • Indicate North <br />proposed structures on the lot • Show any proposed greding changes <br />� Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />L <br />7. All calis for inspection shall be made 24 hra in advance • phone 259•881 5. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Standarcls and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•900-424•5555. <br />`�' �`�►- �/�r� �� �s ¢���� 3 - 2 � - �'°'rc <br />everett PUBUC WORKS DEPARTMENT <br />� 3:200 Cedar Sireet <br />Everetr. WA 98201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />0 <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett Irom 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-ot�way use hereto <br />applied for and (urther agrees to remove same upon notice from the <br />Ciry and to replaye�p�blic property cjart�ged thereby. <br />Signature of Appli'�ant - � � bate <br />WORK AUTI10flIZED BY THIS PEHMIT MUST BF STARTED WITHIN <br />180 DAYS GF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENT�Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CAIJCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />