Laserfiche WebLink
Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />PUEIic Y/o�ks Permi� w <br />aiaa oeo�. + <br />Public Works Fee <br />Ta1alFee $ — <br />Lass AOGI Fee PaiC $ <br />Belance Due S <br />Plan Check No: C 41884 SEPA <br />Applicat.Date: OB/31/93 <br />Job AdOwner: RUKSTA�ISR ARTG& JANE Phone <br />Tenant: <br />Pruposed Use: SINGLE FAMILY RESIDENCE <br />D476SF ADDNik� Phone <br />OFFICE SET JOB SET <br />pPPROVED FOR PERMIT: DATE_/_�_ BY <br />Project Address (if known} <br />Attach lour (4) copies of plans for proposed work - Draw to scale and note the iollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all exis�ing and <br />proposed structures on the Iot <br />• Er.isting and proposr.d utilities <br />• Centerline oF sireet <br />• Indicate Norih <br />• Show any proposed gradin,i ch�anges <br />• Show measuremenls <br />PcRMIT CONDITIONS <br />1. Al! calls tor incpection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be performed in accordance with ihis permit and current Cily oF Everett Design and Construction <br />Slandards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />PUBLIC WORKS PERMIT <br />NOT REOUIRED <br />8Y ` .G' <br />DA7E .� Y 3 <br />Approved tor Construction Da�e <br />FINALINSPECTION <br />Approved as Construcled <br />�A`��PUBLIC WORKS DEPART"qENT <br />3200 Cedar Street <br />EvertlL WA 98201 <br />Phone:259•8810 <br />Date <br />ACKNOWIEDGEMENT OF CONDVfIONS <br />W <br />H <br />� r <br />� <br />O <br />� <br />Y/ <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less lhe City ol Everett trom any and all claims for damages, costs, <br />expenses, or causes ot action ihat may ari;e hecause of installation <br />and maintenance of the improvement or other right-ohway use hereto <br />applied tor and further agrees lo remove same upon notice (rom tlie <br />City and to replace publi: properry damaged thereby. <br />S�gnature of Applicant Date <br />WORK AUTHOFi1ZED BY THIS PERMI� MUST BE STARTED WITHIN <br />180 DAYS OF UATE PEFMIT IS ISSUED AND THEREP.FTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UF"JN ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEIl 90 DAYS DURATION. <br />