Laserfiche WebLink
�'_' <br />oate`� 1 - <br />Application For <br />PU�LIC V1/ORKS PERMlT <br />Print or Type Only <br />Applican� <br />ress <br />Mailing Atidress <br />�� <br />C��y <br />Pu�l¢ Works Perrtyt-¢�_ _ _ <br />�.tl'rc <br />8149.Ocp1. u _ Cl l.J � <br />Pue4c Works Feo <br />TOlal FPe w5 <br />Less ApPI. Fec Paia S <br />ealance Due � <br />Phone <br />City Zip Phone <br />Describe Proposed Work I� n, x���1_S 1����� _ <br />�roject Address (if known) �_�. <br />Atlach }our (4) copies of plans lor proposed work - Draw to scale and note ihe following as applicable: <br />• Property Lines <br />• Outline and dimensions of all exis�ing and <br />proposed sirudures on the lot <br />• Existing and proposed utilities <br />O Centerline ol sVee� <br />• Indicale Norih <br />• Show any preposed gradiny changes <br />• Sliow measurements <br />LINE <br />PERMIT CONDITIONS <br />1. All calis for inspection shall 6e made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pertormed in accordance with this permit and current Ciry of Everett Design and Construction <br />Standards and Speci(ications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-$00•424•5555. <br />Approved for Consiruction <br />�� ���� �� <br />; ,,�'�' b� /:7 �,'8 <br />ACKNOWL[DGLA1[NT OF CONDITIC�NS <br />Th�� undeisign�<d owner/applicant hereby agrees to hold and save harm- <br />---- Ic;s ihc Cdy of Everet� irom any and all claims for damages, costs. <br />expenses, or causes of ac�ion Ihat m�y arise because ef instaliation <br />and maintenance of Ihe improvement or olher right-of�way use herelo <br />applied for and furiher agrees to remove same upon notice from the <br />Date City and to replace public proper�y damaged (hereby. <br />FINAL INSPECTION Date <br />Approved as Consiructed Signature ol Applicant Date <br />evrretl PUBLICWORKSDEPARTMFNT WORK AUTHORIZED BY THIS PE-RMIT MUST BE STARTED WITHIN � <br />� 3200CedarStreet 180 DAYS OF DATE PERh11T IS ISSUED AND THERF.AFTER IS TO <br />Everett WA9b201 BE DILIGENTLI' PURSUED TO COMPLETION. iH15 PERMIT MAY BE <br />Phone 259-8810 CANC[LLED BY THE CITY UPON ANY STOPPAG[ UF 1NORK ON THIS <br />PROJ[CT OVER 90 DAYS DURAIION. <br />