Laserfiche WebLink
Date �� -5_ <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Won, rurmll• d:!r— 2401 <br />Bldg Dept e .5-5-- /SSY/z <br />Public Wallis Fee <br />Total Fee i <br />Let, AppL Fee Paid 7i _ <br />cal. n.e Due $ Zinuep <br />-2 , <br />kr4ME _ <br />Applicant Melling Address City Zip Phone <br />Describe Proposed Work C QW/SoW<iGT !(/EK/ sC F..e.. <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed v. irk - Drew 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 -ttllities • 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 Ch.- if Everett Ti,>i'gn and Construct m <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hrs. befc:e you dig. TOLL eREE NUMBER 1.8V0-424.5555. <br />ys,,c�Et�r�.f-� ifRE rtY�,a.t ,<H�ot�-.d� A��L�dinGG-E <br />TO Tc�m MO:S'T d'F .<'Ef',oi. trr7 .Bf/ ,�iF AA�C.Yan/7 <br />6,' Aw SPovrs feces .eaci� rc Tn B6 /_>is!/fetidEG� <br />C/ivTo SEt'elSrY !���-C's oe/��n t1�yeUEcG � .t/OT <br />everett PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />Everett, WA 98201 <br />201 <br />Phone: 259.8816 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />z <br />O <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett Iroc any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of nstalbdion <br />and maintenance of the Improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public properly damaged thereby. <br />SIgYature-of ApplraAT "" a Date <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 />