Laserfiche WebLink
Date _ <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />Pro�ect Address (if known) <br />Plan Check No: <br />Applicat.Date: <br />3ob Addreee: <br />Owner: <br />Tenant: <br />Propoeed Uee: <br />Desc. of Work: <br />T.I. <br />B 480].9 SEPA <br />04/1Oj95 <br />53b SW EVERETT MALL WY <br />WA SANG ASSOC <br />RINKO'S <br />DESK—TOP PUBLISHING <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the tollowing as applicable: <br />• Prooerty Lines <br />• Outline and dimensions of all existing and <br />proposed struclures on ihe lot <br />• Existing and proposed utilities <br />PUEIic Works Permi� a <br />BICq. DeOt s <br />Public Works Fee <br />Total Fee s _ <br />leas Apo� Fee Peltl �i <br />Balance Uue a <br />Phone <br />Phone <br />• Centerline of ,treet <br />� Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All ralls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Constructton <br />Standards and Specifications. <br />3. Call Locatlon Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />r UBLIC M�ORKS PER�AI� <br />►:O f EOUIREM <br />jY� .__ <br />�i AT E __,����� <br />J___�._�_ <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everelt, WA 98201 <br />Phone:259-8810 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />_ / <br />� <br />O <br />■ <br />Y / <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett Irom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of ihe improvement or other right•ol•way use herelo <br />applied tor and turther agrees to remove same upon notice Irom the <br />City and to repiace public property damaged thereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE D�LIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />