Laserfiche WebLink
Date $�Zi�9z <br /> Publ¢Wo��s Permit• <br /> Application For eioy o�n� , 37774 <br /> PI��LIC WORKS PERIVIIT PVeToialFeeFeB S <br /> LessApGl Fec Paitl $ <br /> Print or Type Only T� `�'�STIN� - BalanroDuc 5 <br /> 11•2T �;� <br /> Randy Cooper 2601 Jackson Everett 98203 347-1208 <br /> Owner Mailing Address City Zip Phone � <br /> Same <br /> Applicant Mailing Address Ci� <br /> Y ZiP Phone <br /> Describe Proi osed Work AAdi tin SFR <br /> Project Address�if I<nown� z601 Sackson � <br /> Attach lour(4)copies of plans tor proposed work- Draw to scale and �ote ihe follov+ing as applicable: � <br /> • Property Linos • Centerline of street � <br /> • Outfne and d�rnensions of all existing and • Indicate No�ih <br /> proposed siructures on the lot • Show any proposed gratlinq chan3es <br /> • Existinc �nd proposed utilities • ;how measurements � <br /> f10 NOT WRITE BELOW THIS LINE /� <br /> PERMIT CONDITIONS V <br /> 1.All calls(or inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2,All work shall be pertormed in accordance with ihis permit and current City of Everett Design and Consiruaion <br /> Standards and Specifications. <br /> 3.Call Localion Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•$00-424-5555. �' <br /> T� ` <br /> � O <br /> /��,, j.i.._ L r. .v-_ /7. . . .( i., �l i_ <br /> '.. <br /> ��r]� � <br /> � .�'� i I <br /> � <br /> O <br /> � <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> _ The undersignetl owner/applicant here6yagrees to hold and save harm- <br /> less the City of EvErett Irom any and all claims for tlamages, cosis, <br /> enpenses. or causes o� action that may arise because of installation <br /> and mainienance of the improvement or other right-obway use hereto <br /> applied lor and further a9recs to remove same upon notice Irom the <br /> App�ovad lor Construction Date <br /> City and to re,place publiC propeity damaged �hefeby. <br /> FINAL INSPECTION Date <br /> ApProved as Constructed Signature of Applicant Date <br /> � r'UBLICWORKSDEPARTMENT �'ORK AUTHORIZED BY THIS PERMIT MUST 6E STARTED WITHIN <br /> �� 3200CedarStieet 180 DAYS OF DATE P[RMIT IS �SSU�D AND THEFEAFTER IS TO <br /> � Everett,WA98201 BE DILIGENTLY PURSUF� TO C(i��1PLETION. THIS PERMIT MA1' BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON Hf•!Y STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS LIURATION. <br />