Laserfiche WebLink
DateG <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Zip <br />Zip <br />Pubbc Wolke Pa,ma• 995 <br />Bing Dept • r(�710-Q <br />- <br />Pubic Wmte Fee <br />Total Fee a <br />Len APPL Fee Paid i �— <br />eaiance 0ue <br />Describe IIJLI�//t'1R7i1TtT/%i//,'�i7//iL'���.1�t2 ;�s>•wr�r �� vs� �- <br />r <br />Project Address (if known) .2 312 " <br />Attach lour (4) copies of plans for proposed work - Draw to scale and note the following as c,:plicable: <br />• Property Lines • Cenierline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show airy proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8815. <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 hra. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />jismLTLDtihL— tvS R�Qt1� lr rl�� tS <br />n, , G22[ S f t0 Lh-rz) <br />To L+IPpSC� w s 'r0 SoLfF} S EA57-wita1J <br />p4Ni I I—X;, Is, etc rs v-3 1 <br />n-tMW-Syk4q <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Approved for Con (ruction^ ate <br />FINAL INSPECTIONDate <br />Approved as Constructed <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />W <br />0 <br />z <br />0 <br />Cl) <br />0 <br />a <br />The undersigned owner/applicant 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 righl-of-way use hereto <br />applied for and further agrnes to remove same upon notire from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Dale <br />WORK AUT40RIZED 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 />