Laserfiche WebLink
Date�.+V� Public Works Permit a `� • ��� <br /> Application For �Idp.DeD�.� <br /> PUBLIC WORKS PERMIT PueTolalFcoFee s <br /> Luss AppL Fec PeiO $ <br /> Balance Due S � <br /> Print or Type Oniy <br /> �fJi.o �EC'��p332 <br /> (� C,in�nt1�� ���1� R►� {��. IY14t2i/�1� t li�.u1 L�Z ��-?- 12Z,5 <br /> w�� 1 Maiiing Address City Lp Phone <br /> Ap„pl�nt MailingAddress City Zip Phone <br /> Describe Proposed Work ��� � � <br /> W <br /> Pro�ect Address(if known) /7/D - E•d��.9,vD A✓E � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ot street � <br /> • putline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <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 Specilications <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUM9ER 1•800•424-5555. � <br /> �� ��'�',e� �OT TO BG Ol/_F/� 8� /�i�rfj� O <br /> S ow,�.�,e �s �PEs�o,�s,.�� f-..� sr•9e,�,�-y o� <br /> SO/G . � <br /> lo. OLtJA/��.' /S ifESPoit/S/�5'c.F �.t /7�A�.t/Ti9i.✓En/l�' /f•t/D � <br /> /f�Ef A/•e Q� �UC,�'%2y b'L�iNEr COif/.STi2!/CTElJ /.t/ T/�.F O <br /> PuBc,c .P,�-.yr_ a�- w.cy, <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm• <br /> less the Ciry ot Everett Irom any and all claims for damages, costs, <br /> ezpenses, or causes ol action Ihat may arise because of installation <br /> � / � and maintenance of the improvement or other right•of•way use nereto <br /> applied for and further agrees to remove same upon notice irom the <br /> A roved lor Construgf' n . ,/bate City and to repla e, lic properry d�d thereby. <br /> --�a��c<<%.�.--_._ 'P�'—�/��-�� //'� <br /> FINALINSPECTION Date �• / / �y� <br /> Approved as Consiructed Sign e of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT H' K AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�8875 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />