6816 EVERGREEN WAY 2022-09-19 - Laserfiche WebLink

Application For Date OLT , PUBLIC WORKS PERMIT Oat) PUBLIC Public Works Permit# PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 (425) 257-8810 Building Permit# TYPE OR PRINT ONLY Public Works Fee$ I?oOLATvc Jb`fori+t giN ev 2Gtei e ivo ele.:17' vy4 "7 V20 3 +�., .�+�Owwner Mailing Address `Phone le) .y ..y City Zip�y Ave well- Applicant f Mailing Address City Zip Phone ' 6 Describe Proposed Work - ' 1 tIT W • .f .c. e0t1e..0 ,i C. /v4 i- fei-Ca/ili'or-d 60-1..4.- +y /V, ee'tirr limm is RRfr t f /,r` ov0 c ti i hort C'.ii9160 (4e01-040-- S�'r,,r .,�')Md" l i M PROJECT ADDRESS (if known) O v it i s C - v 14'6 r e`'�` "� L • W Attach four(4)copies plans for proposed work-Draw to scale and note the following if applicable: O •Property Lines •Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities in •Centerline of street •Indicate North •Show any proposed grading changes •Show measurements DO NOT WRITE BELOW THIS LINE Z PERMIT CONDITIONS: Q 1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications., III 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. CO 4. Ac pe,, le er zA 01 d )71 ,1 -L ed w f e-,,e ,' 0 Q. 57 4,/0/lC 4(o e06 7eu.-enj q A-dd r Z;3Q P44 lvr,../ h c'e 0</ l€1,-0 0,Pen ovf s,-dc 4-Pe Ralkn ° # 99086 OTHER 20.00 o>- TOTS... 20.00 A y� �y�ry CHEK 20.00 OM109? ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harmless 4�struction 3ate 1 /1 the City of Everett from any and all claims for damages •- - penses,or Ap �o / causes . . tion •-t may arise because of', . - on and maintenance of the roe f imp s fe •-nt or other '.ht-of-wa =reto applied for and furt er agrees to o same upon notic- he City and to re.1- - --, property dam- , a.-.thereby. FINAL INSPECTION Date Approved as Constructed ' -- ign."�e o 'pp scan P.te WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS• DATE PERMIT IS I -UED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.