Laserfiche WebLink
SE.��' Tn C,c'cir...�,� <br />/ // -/ 7_�9� <br />Date�° } <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />t <br />Aopiicant <br />Describe Proposed Work <br />Project Address (il known) <br />Atldress <br />cny <br />Public Works Permlt • �+ � ��O <br />BItlO_DeOt • `� S's _ <br />Pu�lic Works Fee <br />Totel Fee a <br />Less AppL Fea Pald s pp <br />Baiance Oue S ��— O�7 � <br />��/ � <br />.C�'�� ��a� `l�Boi� 48f-os7i <br />ZiP Phono <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />� Property Lines <br />• Outline and dimensions of all existing and <br />proposed shucture� on the lot <br />• Existing and proposed utilities <br />• Centerline ot street <br />• �ndicate North <br />• Show any proposed gratling c,Vanges <br />� Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calis for inspection shall be made 24 hrs. in advance • phone 259•8815. <br />2. All work shall be performed in accordance with this permit aod current Ciry of Everett Design aotl Construction <br />Standards and Specificationa <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />y io' � ro,�sT,�a�T,�� �� Ao�,�o�� <br />��,a.vs L��F� �o-�v-8s <br />.5: �4 �'F.e�,�..�a,�cF �va,ea.�,—y �,Z <br />�`inP.�-'or4�t-ien/�s `ae ,�` /j ois �s <br />/�,QovioE� <br />i/-aa-AS <br />S.—.�F'E'T <br />L�/i/L fiF <br />�y T.�f �P.�c ��a.vr ��- 8y <br />o,e T,Yis /��'o7FcT Gdi�G BE SNuT ,Gb[Jdl, <br />Y�� <br />����c�� //-/f<-8S <br />Approved lor Con ction Date <br />��— i 1 2�% <br />FI AL INSPECTION Date <br />Approved as Constructed <br />everett PU6LIC WORKS DEPARTMENT <br />� 3200 Cedar Siree; <br />Everett. WA 98201 <br />�hone: 259-88 7 5 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />The undersigned owner/applicant hereby agree= to hold and save harm� <br />less �he City of Everett from any and all claims for damages, cos�s, <br />expenses, ur causes ol action that may arise bewuse ol instaltation <br />and maintenance ot the iinprovement or other right-ol•way use hereto <br />applied lor and lurther aprees to remove same upon nolice irom the <br />City and 1 replace public operty damaged thereby. <br />1�} IJO IP �� <br />Si�na ure o ppliCant Date <br />WORK AUTHORIZED BY THIS ERMIT MU�T BE STARTED WITHIN <br />780 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGEIJTLY PURSUED TO COMPI.ETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />