Laserfiche WebLink
Da',.e o? 5 � � <br />ApplicaL,,.. For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Mailing Address <br />� Pe�lic Worhs Pmmlt • <br />eieo. o�o�. • �%� _ <br />Pu�l¢ Worke Fee S <br />Totel Fee <br />Leas Fpo� Fea Pa10 S <br />eainnce oue S <br />sa srag-_����g <br />ZiN Phono <br />,11e_ _��aZ ](') !0 Jr 3 —.a� 07 n/ � <br />Zip Phone <br />Describe Proposed Work �T�1 �n()y� 7— :,m�,�rn�p��,� 1� _ <br />Pro�ect Address (if known) <br />Attach lour (4) copies of plans for p�oposed work - Draw to scale and note :hE lollowing as applicable: <br />• Property Lines � <br />• Outline and dimensiOns ol all exis�ing and <br />proposed structures on the lot <br />• Exis�ing and proposed utilities <br />PERMIT CONDITIONS <br />• Centerline ol sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />t. All calls lor insaection shall be made 24 hrs. in advance • phone 259•B81 5. <br />2. All work shall be pertormed in accordance wilh �his permit and current City ot Everett Oesi9n and Construction <br />Slandards and Specificaliona. <br />3. Gall Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />` C�LS'C:C �G�.:�,�.c''S %��/��ij .UVT .E'E�cii/'E�O <br />, � <br />.,? /_�/i�7 <br />Appraved lor Construclicn <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everelt PUBLIC :;OHHS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259�8815 <br />ACKNOWLEDGEMENT OF CONLiTIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett irom any and all claims for damages. cos�s, <br />e■penses, or causes ol action that may arise because ot installation <br />and maintenance ol the improvement or o�her righPol�way uee herelo <br />applied lor and further agrees to remove same upon notice irom the <br />City and to replace public proper�y damaged thereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAVS 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 />