Laserfiche WebLink
�� <br />Date Z�11/92 <br />�'1 <br />Applic2tion For <br />PU6LlC WORKS PERM9T <br />Print orType Only <br />(TENANT — HAA of Wash.) <br />r��� I Public Worb Permll e___.. <br />uiae.o�oi.. _ y2 356'1.3 <br />Pu���c works Fee $ <br />TO�01 F9P <br />Lesa Appl Fee Paia $ <br />Balance Duo $ <br />Kurisu a Fergus 900 Fort St. Mall #1355 Honolulu, HI (808) 523-5644 <br />nw„�. Mailing Address City Zip Phone <br />S.J. Barrett & co. Inc �6^'^ "^ ` A1nA u.� o d wa 9R059 88 -�ntl <br />Applican� Mailing Address ^^ Ciiy Zip Phone <br />Describe Proposed Work '�nant improvement <br />ProjeCl Addres5 (il known) <br />Attach four (4) copies of plans lor proposeo work � Draw to scale and note ihe following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all exisling and •!ndicate North <br />proposeA struciwes on the bt • Show any proposed grading changes <br />• Existing and proposed utilities • �how measurements <br />PERMITCONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accurdance with this permit and current City of Everett Design and Conslruction <br />Standards and Specilications. <br />3. Call Location Underground Service 4B hrs. helore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />:J�G��, w�-�/_ f-��,:...��� 2��.��,�� <br />� <br />2 � z -i2 <br />Approved lor Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS OEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone:259�8810 <br />W <br />H <br />�w <br />_ / <br />z <br />0 <br />F" <br />� <br />0 <br />a <br />ACKNOWLFCGEMENT OF CONDITIONS <br />The undersigned owner/anpGcant hereby agrees to hold and save harm- <br />less the City of Everrtl from any and all claims for damages, costs, <br />expenses, or causes ot action that may arise because of installation <br />and mainlr.nance of the improvemenl or olher right-of-way use hereto <br />apPlied for and further agrees to remove same upon notice irom the <br />Gily and to replace public properry damaged thereby. <br />Si9nature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMITISISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COM°LETION. THIS PERMIT MAY B[ <br />CANCELLED BYTHE CITY UPON ANY STOPPAGE OF.NORK ON THIS <br />PFlOJECT OVER 90 DAYS DURATION. <br />