Laserfiche WebLink
�ate�LL�� <br />Pnolir..,�on For <br />PUBLIC VI(t�'�i�kS PERI►JIIT <br />� <br />Public Wo�hs Pc�mi1 • � � / � <br />o'G7. Onol. • �__ <br />PuEllc WarMe Fea <br />To1ai Fee 5 _ <br />- I Less AOo� Fea Paitl � _ <br />Print or Type Only BalanceDux s_/'i 52 '?�' <br />' A)� �iY' q�2. �rc� �lU� �i)E o.�LgTiL� 4�;�� ��7�:n� <br />Owner Afailing Address City Zip Phone <br />C�/�� �}�-t''1�/TF�,�'TS /l�y�!, C/4/lL�'l°JTt/ 4// ��iil.��12��7�E�Z< <br />Applicant Mailing Atldress - City �� Zip phona <br />Describe Proposed Work %� �/�/1�%//�/�.���l�{� <br />� Project Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines - <br />• Oullina and tlimensions of all existing and <br />proposed structures on the lot <br />• Existing and propcsed uHlitles <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMITCONDITIONS , - <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259-881 5. <br />2. All work shall be pertormed in accordance with this permit and wrrent 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-$00-424•5555. <br />`�. Tv .,�� Co.vs,-,�v�.,-fa P�,e .q��iza�;� � <br />s�,-� ���,✓s �H.-�� � - �- �� <br />J�. �-/�/�G /C9it/ � /%L S7' /�.2J d/�E /-�E/1FD.c'J��NC� . <br />GU�o,�',��/Ty �.e �c..i�,P.� B�Fo.�E $�//c.1Ji�t/G <br />/��;%1f�'/%'� 9.e�E iss4�0, <br />C� n p <br />�� ��Y u/�� <br />� Approved for Constr tion a�g <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />b <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett. WA 98201 <br />Phone:259•8875 <br />. � �: ;•�.... . . <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />The undersigned o•.vner/applicanl hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damagea cosls, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of ihe improvement or other right-o!-way use herelo <br />applied tor and furiher agrees lo remove same upon notice Irom the <br />City and to r olace public property damaged thereby. <br />/ ��/' r <br />Sic�nat, f Applicant Date <br />WOR � AUTH091ZED BY THIS :�EHMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT I;i 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 THIS <br />PROJECT OVER 90 DAYS DURATION. <br />