Laserfiche WebLink
Datela 87 <br />�� �� Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />L:Ily <br />Applicant Meiling Address Uily <br />Describe Proposed Work �� /C" <br />Project Address (if known) <br />7n *5 <br />PubhC Wp... Permil • _y �� <br />r <br />Bldg a.pl <br />Public WOO f Fee s <br />7.L.l Fee <br />Len AWL Fee Pup <br />B.I.nN Due i <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Linea • Centerline of street <br />• outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />Phone <br />Phone <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 City of Everett Design and Construction <br />Standards and Specifications <br />3. Call Location Underground Service 48 hrs before you dig TOLL FREE NUMBER 1.800.424.5555. <br />Tf iN ikrw•dJR^vn To be,,,141i1015E <br />.S .iivEs✓!7c C iS idEc✓ Lrd��oGE•t/� /✓�i'uCeA17 To <br />r('Er'LgCE .9ti/ �''miOC.{D l�UriNG Con/STedcT,O.</. <br />7 Any/ GC9oi v(r Do.r.- a l/ .COT -toe, SHA46 dE 49,. <br />So .�.s Nor To ja"'OgcT .90�. v� v� 6ors War i <br />,P,o •�uwAr6e 'evx` rQr, <br />Approved for ConssAction ate <br />z-lILI65 <br />FINAL INSPECTION Date <br />Approved as Constructed <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sheet <br />Everett, WA 98201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />to <br />0 <br />M) <br />z <br />0 <br />0 <br />a <br />The undersigned ownertapplicant hereby agrees to hold and save harm- <br />less the City of Everett from 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-ol•way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />ftnature of Applicant <br />WORK AUTHORIZED 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 BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />