Laserfiche WebLink
A <br />aHrA <br />y1 <br />1.4 <br />�� <br />x <br />CH <br />�a 0 <br />NH <br />x <br />g rA 1-3 <br />n r4 <br />OrA <br />Date-41121191 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�1 <br />0111111, uLlm Warble Permit <br />Bldg oepl. e _ 91/26625 <br />Pablw Works Fee s <br />Tnlal Fee <br />Lou Appr Fee Paid S ', <br />Balance Due S <br />r <br />4�0 d996 <br />Everett School District 4730 r_nlbv - F1eiPCii gB2ni-- Phone <br />Owner <br />Mailing Address y t <br />Finley Zip Pher•e <br />Applicant Mailing Address <br />Describe Proposed Work <br />ds.SZOcin6—at—f`Ver-g�2en--W�ddie—Sehe9 — <br />Project Address (If known) <br />filtic <br />Attach four (4) copies of plans for proposed work • Draw to scale and note t Centerline of stow ng reet <br />able: <br />• Property Linea •Indicate North <br />• Outline and dimensions of all existing and • Show any proposed grading changes <br />proposed structures on the lot 0 Snow measurements <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 him in advance • phone 259.8810. <br />2. All work $hall be performed In accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 fire. before you dig. TOLL FREE NUMBER 1.800.424.555 . <br />9rB <br />Approved for Construction Date <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 Street <br />Everett WA 90201 <br />Phone: 269.8810 <br />us! <br />mm <br />W <br />in <br />0 <br />Z <br />0 <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm, <br />Everettless the City of any and <br />ges. costs. <br />expenses, or causes of action lclaims may arisebecauseofinstallation <br />and maintenance of the Improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Data <br />WORK AUTHORIZED BY THIS IT MUST BE STARTED WITIN <br />B0 DAYS OF DATE PERMIT 113 SMUED AND THEREAFTER ISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT O IER 90 DAYS DURATION. <br />