Laserfiche WebLink
Date �-23-93 <br />Applica�ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Onl� <br />PuEllc Warks Patmit r �3 3z / <br />eiae. oaa�.. <br />Public Works Fee <br />Tolnl Fea S <br />Less ApO�. Fee Paltl S <br />O.� <br />ea�eooe ooe S Z..S G�uv�n <br />Frontier Bank PO Box x215 Everett 98203 514-0712 F. Earl Carey <br />Owner MailingAddress City�� ;; � Zip phone <br />Owner <br />Mailing Address <br />City Zip I'hone <br />Describe Proposed Work cleai Veget;itiOn _ <br />Prolect Address (if known) <br />4th Ave W& SE Ev Mall Wa <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicabla: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />prcposed structures on the Iot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate North <br />� Show any proposed grading changes <br />• Show mezsurements <br />PERMIT CONDITIONS <br />1. All ca�ls tor inspection shall be mede 24 hrs. in advance • phone 259•8810. <br />2. All work shell be pedormed in acwrdance with this permit and wrrent Clty of Everett Dea!gn and Constructlon <br />Standards and Speciflcations. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FflEE NUMBER 1•800-424•5555. <br />� F YDS/r1Y+� CGYI �J�� �✓ C[ �-� I'1.�1�/b✓' <br />� <br />A oved� structio Date <br />� /; <br />i" ,-' j <br />'" 1 <br />FIN � I PECTION ( Date <br />qpproved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everetl, WA 98207 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City o' Everett from any and all claims for damages, costs, <br />expenses, or causes of action ihat may arise because of instaltation <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 />Ciry and to replace public property damaged iheieby. <br />� '��,.C� 11� Z z-4 � <br />SignaWre of Applicant ate <br />WORK AUTHORIZED BY THIS PERMIT M ST BE STAFTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TH�S <br />PROJECT OVER 90 DAYS DURATION. <br />- <br />