Laserfiche WebLink
S(�% i. �/%'� �,,: z: ?= i-3 "l <br />Date, r� � r> / <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />icant <br />Address <br />Glry <br />Describe Proposed Work ���� �NT��^ 1�.f� �� I! Y/'1r�0�`� <br />Project Address (if known) <br />PWlir Works Pvrmi� s �� /�� <br />BIEO. Dept. r <br />PublicWoiksFcc S <br />Tolal Foo <br />Less Appl. Feo Paia 5 <br />�:n <br />BalencoUue $ ���� <br />Atlach lour (4) :opies of plans for proposed work - Draw to scale and note ihe id�pwing as applicable: <br />• Pwperry Lines .• Centerline ot street <br />• Outline and dimensions ot all exisling and • Indicate North <br />pi�posed slruclures on the lot • Show any proposed grading changes <br />• Existing and proposed ulilities • Show ineasuremenis <br />Phone <br />rnune <br />PERM!T CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All wnrk shall he performed in accordance wilh ihis permit and current City ot Everett Design and Conslruclion <br />Stancards and Specilications <br />3. Ca9 Location Underground Service 48 hrs bcfore you dig. TOLL. FREE NUMBFR 1•800•424-5555. <br />T ;SiTE !<:l.�;C Ta fE/ Pc'�,�E /'E.� %�i�::c�:✓En /�CA.�� <br />!�5'7c'/> S—/-�%'7 / �%T1/JC/fE/] C"!/'�� <br />J �7c��F'fTi'7G'���5� ECEt/-/�Tini✓ C'O/'JTiC'!!.. �?[�iNT I�E�K'F <br />.9/].T� ST/Ncr EXis'.—i�✓C C<J7C'i� G'/-/.'Ji.G�: <br />� �j/J�!/l�iti% %U %,/-'C76�/�E" ��f.C'!.�/�ln^NCE .�iC-���'i/nN%� <br />jlc'y� �'r / �•C/�'J/-T-I ���2•' h'c'� Z�.JC-'FlJ, <br />for <br />FINAL"INSPI <br />Approved as <br />everett <br />I� <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-8815 <br />9-1/•J <br />Date <br />W <br />H <br />� <br />N <br />� <br />O <br />� <br />N <br />O <br />a <br />.4CKNOWLEDGEMENT OF CONDITIONS <br />The undersi9ned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from aoy and all claims lor dama�es, costs, <br />expenses, or causes ol action that may a:se ber.ause of installation <br />and maintenanr,e of the improvement or other right-of-way use hereto <br />applied for and luriher agrees to remove same upon nolice Irom the <br />City and to repL•ice public property damaged thereby. <br />Signature oT Applicant "��� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLED BY THE CITY UPOPJ ANY STOPPAGE OF WORK ON THIS <br />PRC JECT OVER 90 DAYS DURATION. <br />