Laserfiche WebLink
� �Plication For ;/� <br /> PUBLIC WORKS PERMIT oate_ C� /�4/q� <br /> PUBLIC WORKS DEPARTMENT Public Works Permit# _ ��/Z 3� <br /> 3200 Cedar Street <br /> Everett,Wq ggp01 25g-8810 <br /> Building Permit N_ <br /> TVPEORPRINTONLY '��' ��JSTING �y <br /> N� � 5 �99� public Works Fee$ � I S s <br /> �G� Su�cG Mt,ah;h;sfs lln;on aIZS l5�P15� Sea�l'}IG q8)oa �Q <br /> Owner � MaihngAddress ��v �3� <br /> City Zip Phone <br /> �G►^rv Su�d;ck (,49-3531 <br /> Apphcant Mailing Address <br /> C��' Z�P Phone ;. <br /> Describe Proposed Work ��ZQ� �Y'Q� i�'1 5'IZ.. �I e/`OSiO✓1 CO�1'�'� ) prld <br /> Tenq ar cw�c.���k'o ia 1 d Co�s4rvc.-F�o,� �h�lrqnce4 � <br /> _ Gnd SRwGc1♦ 72i�Gwl�- � <br /> PROJECT ADDRESS(ifi known) 8�]Z�i ,�irvor{- Ko�d � <br /> Atlach four(4)copies of plans for proposed work-Drew to scale antl note the foliowing ii applicable: � <br /> 'Properry Lines �putiine and dimensions of all existing and proposed stmctures on the lot •Existing and praposed utilkies � <br /> `Centetline of street •Indicate North 5how any proposed grading changes •Show measuren�ea,s <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: � <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259•8810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and O <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-4?4-5565, � <br /> �� �i �' p l�N T�raucd�wd d� <o�4�qG �vd 2S � <br /> � G�-}•J ��b�;t �rer�s �ns�ec.-4ars rJlrtc�ton;v� f�eld. Q <br /> a <br /> OG/i4f96 4=56PY4 �62b <br /> 1 <br /> N0�96230 <br /> 6TtflER t100.0� <br /> GRR6NG f75.00 <br /> CNECt: t1:75.OQ <br /> 0 <br /> � ACKNOWLEDGEMENr OF CONDIIIONS <br /> A���� /— _� J The undersigned owneAapplicart herehy agrees to holtl and save harmless <br /> ��—. � '� Cr6 the Cfty o(Everetl from any and all claims for damages,costs.expen:xs,or <br /> u tor C tructio Cate causes of action that may arise beca.use of installation anC maintenance of <br /> („ the improvemeni or other right-of-way use hereto applied for antl iurther agrces <br /> � : i� to remove same upon notice from the Crty antl to replace public property <br /> L� � ��/ '�'J damagedthereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed <br /> Si ature of icant ate <br /> WORK AUTHOR2ED BY THIS PEflM1T PAUST BE STARTED WITHIN 180 DAYS OF DATE RMIT IS I ED AMD THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY 7HE CI7V UPON ANY STOPF�GE F WORK N THIS PROJECT OVER 90 D�4yS WRATION. <br />