Laserfiche WebLink
Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />City Zip <br />Pu1,1¢ Works Permit • -0 <br />BIpG Dept • � 3 %� <br />Public Works Fee �� O <br />Tolel Fee >f <br />Less Appl Fee Pele <br />6e1a,,ce D. <br />Si9,tfE' /�JfC /4/3cn✓F — <br />Applicant Mailing Address City Zir Phone <br />Describe Proposed Work /v//Pw -J rp, _--.—.-- <br />+� 89Qth(]Street S.E. <br />Project Address (if known) ry -I S' E 1-. V% <br />Attach four (4) coples of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • 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 measL-ements <br />M <br />DO NOT WCfFE BELOW THIS LINE <br />PERt..IT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.881 5 <br />2. Pit work shall be performed in accordance with this permit and current City of Everett Design and Conslructio, <br />Standards and Specifications. <br />A. Call Location Underground Service 48 hrsbelore yov dig. TOLL FREE. NUMBER 1.800.424.5555. <br />APPMVed o 'on Flats <br />((((\\\v , ' � <br />FINAL INSPECTION' -St��/ Dele <br />Approved 95 Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />everett <br />Phone: 259.8815 <br />r49 <br />L_i <br />v/ <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/apu6cnnt hereby agrees to hold and as a harm- <br />less the City of Everett from any and all claims for damages, r-o:ts, <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 agrees to remove sr,me upon notice from the <br />City and to replace public property damaged thereby. <br />SI nalule of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS Or DATE PERMIT IS ISSUED ;ND 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 />