Laserfiche WebLink
Date�L!,�� <br />Application For <br />PUBLIC WORKS P�R11iIIT <br />Print c,r Type Oniy <br />i Ilr <br />Owner <br />Applicant <br />Desa�ts Proposed Work <br />Prolect Address (if known) <br />Mailing Address <br />Mailing Address <br />� ���1� <br />Ciry <br />City Zip <br />P�pLc Wcrks Pprmit a� 7 V/.��'�'� <br />e�ac. oea�. . �� / � % �i % - <br />Fuo�ic worMa Fee — <br />Tolel Fae S __ <br />Lee9 FOPI. Fee Paid S <br />oaiance nuo S 2G�� ��� <br />���� <br />� �v`��y�f�: ) <br />Attach four (a) copies of plans (or proposed work - Draw to scale and no�e the icllovring as applicable: <br />• Property Lines ^ Centerline of street <br />t Outline and dimensions of all existing and • Indic.^.le Norih <br />proposed siructures on Ihe lot (: Show a�y proposerl yrading changes <br />• Exisfing and proposed utilities 0 Sho�.v measuremems <br />11�:J7 <br />Phare <br />PERMIT CONDITIONS <br />7. All calls lor inspection shall be made 24 hrs in advance - phone 2S9•$81 5. <br />2. All work shall be performed in accordance with this permit and current Ciry of Everett Design antl Gonstructinn <br />Standards and �pecifications. <br />3. Call Location Underground Service 48 hrs. betore you di�. TOLL FAEE NUMBER 1-800•424-5555. <br />. <br />FINALINSPECTION 1\ � <br />Approved as Constructed v <br />evere[t PUBLIC WORKS DEf'ARTMENT <br />3200 Cedar Shr.et <br />Everett WA 98207 <br />Fhone 25&BB15 <br />Date <br />ACKNOWLEDGE�dENT OF CONDiTIONS <br />The undersigned owner/applicanl hereby agrees to hold and save harm- <br />less the City ol Everett lrom any and all claims for tlama9es, cosfs, <br />expenszs, or causes of action that may arise b?cause ot installation <br />and maintenance ol ihe improvement or olher ri�ht-ol�way use hereto <br />applied lo and further agr?es to remove same upon notice Irom ihe <br />City an o place public proparty damaged thereby. <br />n <br />�y� / <br />W�'c�i �\ � Gti'Y'"cz¢i <br />Signature ol Applicant Dale <br />WORK AUTHORI2ED BY THIS PERtv11T M�JST BE STARTED WITHIN <br />18U DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURgUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPOP� AN'f STOPPAGF O� WORK ON l f-Ii�.� <br />PROJFCi OVf R 50 DAYS DUn^ATIOIJ. <br />G <br />�. <br />:: <br />