10822 EVERGREEN WAY 2016-11-07 - Laserfiche WebLink

� �at� � -5 Application For �'UBLlC WORKS PERNII� r a �� ' Public Wo�ks Permit c�, _ �.. c� Bldg. DepL u ��i�lYr—r— P�bhc Works Fez S Total Fee — Less Appl FBe Pa:d S — �'O Balance Due S ��-� Print or Type Only �575�,.�; � �-3 I oszz j-}-w��i �n.�- �i�� Owner �'��in� �+�dress C�ty 7_ip Phone ,� �r�, rv_.�,� Applicant Describe Proposed VVork D�?3ili�q Address -f- ,�oc� �0 5 � ur � ..- --- Project Address (if known; i v�'� �- � �v��—��--�—�a" —r� : - � �ny ^n:-;!�;5--}- Attach four (4) copies of pians `or proposed work - Drav. to scaie an:7 ncte tha `ol!e�virg as aoplicab!e.`�'' ��' �" - -��- -- . • Property Lines • Centerline of street � : . _ �: �:�^�. t. - , y � Outline and dimensions of all ex�sting and o indicate North ;'=:-_- ,- s �how an eposed radiri��anaes `°�-�_. propos2d structures on ihe lot y�' `� _ "_ _� • Existir�q and proposed utflities • Show measurements _—_ :_�',:1,: ��..rn � ��sx� � �n CitV Zip Phone �-- �.� �� � �� �--- — � , - � �' � . . "r; � �"J ' � C.7:�' C � DO NOT WRITE 6ELOW THIS LINE PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259-8810. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM BER 1-£i00-424-5555. � �'Oh,sfrv�7� S'�^�l 7'z � Cz Q �o�� , ' /l / C�7� LcJOI-�� Q r"'¢ �t -C'c -S- d/!'e C�rz o� �vJ% L�G ��or�-S /hS'�2G7Lo/^_ �-��.' S' 7'� Sl o�a �fr �hrz c i-f y s � 7r�P�� w,��J � C Lr�y .S-��-�Q� 2 D8 , �, .SG��c� G��oSG� ��f� CcY'��' Lt�r��r� �S ��CcyS b� Ca�,-��L.�f�ns [�Or�- 7 fiG�G�� S7�i�ee�1' rov��Gt'or Co`nst�ctio FINAL INSPECTION Approved as Constructed PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, W� 98201 Phone:259-8810 CL�?�� -( � LL �� ACKNOWLECGEMENT OF CONDITIONS The underciqned owner/applic2r,t hereby agrees to hoid and save har� — � less the City of Everett from any and all claims for damages. cos � expenses. or causes of action that may arise because of installati� �.y�� ; and maintenance of the improvement or other right-of-way use here d ; a�p��e��: fer and further agrees to remove same upon notice from t a1� ; ��, o rep 2 publlc properiy �amaged thereby. � � D a t e � � �--� � � i I��_�^'�-� � I Signa -re of Applican! Date � 1,NOR1'. AUTHORIZED BY THIS PERMIT MUST BE STARTED WITN I 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS � BE DIUGENTLY PURSUED TO COMPLETION. THIS PERMIT ��IAY I; C.4^JCELL�D B'( THE CITY UPON ANY STOPPAGE OF WURK ON TI- i PRO_IECT OVER 90 DAYS DURATION.