Laserfiche WebLink
Date /�©A'e- '�Public Works Permit# / <br /> Application For Bldg.Dept.# <br /> PUBLIC WORKS PERMIT Public Works Fee <br /> Total Fee $ <br /> Less Appl.Fee Paid $ <br /> Balance Due $ 0 o d <br /> �-- <br /> Print or Type Only <br /> /) 77.-- <br /> Di,,J/0/A- i ak ) 4/9,z 5 <br /> Ovun@ ` MaiUing Address } City Zip Phone <br /> AKllicant Mailing Address City Zip Phone <br /> Describe Proposed Work /)S�GY/-` l'J-/v-e te.Joe--7 <br /> "7 �/"-,47 -��c C/ v: C' / Cam/ <br /> l' / W <br /> IIProject Address(if known) 4`9.( /)) ) ) . 1/2�-C%/ <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: mom <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and •Indicate North CO <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> Ca <br /> DO NOT WRITE BELOW THIS LINE Q <br /> • PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259-8815. <br /> 2. All work shall 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 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555. z <br /> /. Die'/+"c,---'"./ c-eAt7. „ ''G'..-'i %p e-1) :1-t/ %'4=G G^.,C2 0 <br /> ism <br /> CO <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> • less the City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> ----- /Q �L 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 /> Approved 4 r Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date �� r/ A-) <br /> , -a�' <br /> Approved as Constructed Signature of • icant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUT •RIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> klat <br /> Everett, WA 98201 <br /> treeBE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />