Laserfiche WebLink
Date�L �� <br />Application For <br />PU�LIC WORKS pEPl19JIIIT <br />Print or Type Only <br />PubLc Ylo�ks PermJ • q <br />oma. oe�!. • �—�—J—Q�_—_ <br />PubLc wo�ks Peo <br />Tolxl Fee S <br />Le55 Appl. Fee PdiO 5 <br />Baiance0uc $ <br />�,rI�1�Nh ��Wz /�h2T�) 14(1? SE F✓oiPYfMa/lCt/a✓ E�P�ayf �jS".2�/ <br />Owner Mailing Address City Zip Phone <br />City Zip Phone <br />Describe Proposed Work � ��,r���A/'nblO�'�(��f� ��,�_�G�� /S/Y�Yi/�jp4 <br />Project Address �it tnown) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the tol�^wing as applicable: <br />• Property Lines • Cente�llne ol street <br />• Outline aud dimension� of all ezisting and • Indicate Nor�h <br />proposed sirucfures on the lot • Show zny proposed grading char�9es <br />• Existing and proposed utilities • Show measuremenls <br />LINE <br />PERMIT CONDITIC�NS <br />1. All calls (or inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City ol Everett Design and Construclinn <br />Standards and Speciiications. <br />3. Calf Location Undergro�nd Service 48 hrs. before you dig. TOLL FREE NUMBER'7 -800•424-b555. <br />Approved for Construction <br />FINAL INSPECTIUN <br />Appruved as Conslr�cted <br />everett PUELIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 90201 <br />,r� Phone:259-8810 <br />,s' [.�) <br />.CG ' / � C� <br />J <br />Date <br />Date <br />ACKNOWLEDGEM1IENT OI" CONDITIONS <br />�� <br />� <br />The undersigned owner/applicant hereby ag�ees to hold and save harm- <br />�ess the City ol Everett Irom any and nll ciaims for dama�es, cosls, <br />ezpenses, or causes of action that may arise because of installation <br />and maintenance ol the improvement o� other right-ol�way use here�o <br />applied for and furiher agrees to remove same upun notice Irom the <br />City and to replace public property dam2ged �hereby. <br />Signature ol Applicant Date <br />WORK Ai1THOR12ED BY THIS PERMIT PAUST BE STARTED WITHII� <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAF".:R IS TO <br />BE DILIGENTLY PURSUECI TO ::OMPLETION. THIS PER1�11T MAY BE <br />CANCELLED BY THE CITY UPON '�hY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DA1'S DURATION. <br />