Laserfiche WebLink
, <br />Uate "�"Q� <br />Application For <br />PUBLIC WORKS PERMI�' <br />Print or Type Only <br />Owner <br />Publs Wurk, Pmmil a —��� <br />oia7.00ni.. �L-{ ��� <br />Pu0licWoiksF�o S <br />Tolal Feo <br />Lase Appt Fao Paltl S <br />Baionce Ouo 5 <br />� <br />:ii��S�'� �l,��l� �Ji0u:3�1� <br />City Zip Phone <br />DescribeProposedWork ������ .�.k.��rK����%�[ev� <br />Project Address (it known) <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note ihe following as applicable: <br />• Proper�y Lines <br />• Outline and dimensions of all exislin9 �nd <br />proposed structures on ihe lot <br />• Existing and proposed utilities <br />• Centerline of sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be ma�a 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City ot Everett Design and Construction <br />Standards and Speciticatlons. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />/' y_z -s� � <br />/�UfCi G' GlJ�,C�,fyS' ; ��2/ya'T /iJ0% �'6"yiU%�'_/--� .��' <br />Approvad for Construction Date <br />FINAL INSAECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 CedarSireet <br />[verett, WA 98201 <br />Phone:259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />0 <br />The undersigned owner/applicant hereby agrees to hold �nd save harm- <br />less the City of Eveiett trom any and all claims for dama�es, costs, <br />expense�. or causes of action that may arise becaase of inc�allation <br />and maintena.�ce of the improvement or other righbof�way use nereto <br />applied for a,id further agrees to remove same upon notice from the <br />City and to :eplace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEfiEAFTEP IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK GN THIS <br />PROJECT OVER 90 DAYS DURATION. <br />