Laserfiche WebLink
Date�L� 6 <br />Application For <br />PUBL.IC W�RKS P�RMIT <br />Print or Type Only <br />Cily <br />Mailing <br />Describe Proposed Work nf� � 7� CMI�b> rPJvr%Fnr � <br />Project Address (if known) <br />P�LLc 1YOBs Prrmil ✓ — <br />uiao. Dco�. + .�� 5 2— <br />Pu�l¢WorkSFee S <br />Total Foc <br />Lms ApVI. Fee Pai� $ <br />Baiance Ouc $ <br />Phone <br />Zip Phore <br />Altach four (4) copies ol plans lor propused work • Draw lo scale and note the following as �pplicable: <br />! Property Lines <br />• Outline and dimensions of all exis�ing and <br />proposed structures on the lot <br />• Existinc� and proposeA utilities <br />• Center�ine ol streel <br />• Indicate Norih <br />• Show any proposed grading �hanges <br />! Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current Ciry ot Everett Cesign a�d Construction <br />Standards and Spec:lications. <br />3. Call Location G��Gr.rground Service 48 hrs. be(ore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />1-✓Ci <br />/��B�.G �< �c�.�:s rc.�.»,i ,c'Ec��.�-�'�=� <br />Appro��ad for Consiruction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Gedar Sireet <br />Everett WA 98207 <br />Phone:259�8815 <br />c�//L <br />� �� . <br />��/�. <br />AGKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />�w� <br />M / <br />� <br />� <br />�he undersigned owner/applicant hereby agrees to hold anA save harm� <br />less the City of Everet� from any and all claims for damages, cos�s, <br />expenses, or causes of action ihal may arise because of installation <br />and maiMenance of �he improvement or other right-oi�wey use hereto <br />applied for and funher a9rees �o remove same upon nolice hom ihe <br />City and to replace public pwperty damaged thereby. <br />Date <br />Signature of Applicanl Date <br />WORK AUTHOfiIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY �URSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />� PROJEGT OVER 90 DAYS DURAT:ON. <br />