Laserfiche WebLink
Date ° r rr Y <br />I Application r-('- <br />PURLIC WORKS PERMIT <br />Print cr Type Only <br />rleL� LnAJ3�. <br />caner Maihng Address <br />Publw;WPAs Perms• "V /yea <br />emv oePr. • // 'd-4.2,A <br />Public Worse Fee <br />Total Fos �- <br />Lot Appt File Paul i — <br />BalanceDue <br />53 <br />3 9 - `VYO�-" <br />Applicant Moiling Address City Zip Phone <br />Describe Proposed Work <br />'rolecl Address !if k iown) <br />-$ nN V .0 <br />Attach four (4) r opies of plans for proposed work - Draw to stele and note the following as apphcEple: <br />• P. )party Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indic?to N,rth <br />proposed structures on the lot is Show any i reposed grading changes <br />• Existing a,.d proposed utilities • Show measuremen,s <br />PERMIT CONDITIONS <br />1, All cells for inspection shall be made 24 hr& hr 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, Coll Location Underground Service 48 hr& before you dig. TOLL- FREE NUMBER 1.800.424.5555. <br />Approved for G(oJ�jtruction Date Q� <br />1 J Q 1 �Cl A lk_ i '141 l V <br />FINAL INSPECTION <br />Approved as Constructed <br />W <br />PUBLIC WORKS 0 <br />3200 Cedar Street <br />Everett, WA WORKS <br />Phone: 259.8815 <br />M <br />®. <br />am <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all •:Iaims for damages costs, <br />expenses. or causes of action that may arise because of Installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same Loan notice from the <br />City and to replace public property damaged thereby. <br />6lphetura of Applicant Deto <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 />