Laserfiche WebLink
C(1/2C/Cf <br /> Date v '1'IV v'- O Q 2.. Public Works Permit# <br /> Application For Bldg.Dept.# <br /> PUBLIC WORKS PERMIT Public Works Fee <br /> Total Fee $ <br /> Less Appl.Fee Paid $ <br /> Balance Due $ <br /> Print or Type Only <br /> 6-'1e ,w . <br /> fii-ilk Po 3 <br /> Owner Maibing Address City Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> r , <br /> Describe Proposed Work ^ , r l 4-•f_ d" Lt ' \r1(,`t„�- C-) i„� Ar &X i a' <br />- `? fT) 6 ro,7) Ace, �/ A`J1 I 0 4 '4 CF D ! )1,it?LoM A U . <br /> ........ <br /> _ W <br /> Project Address(if known) .� ,0 .1—0 � ' 0 <br /> I..'- <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: aimi1 <br /> • Property.Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North Cn <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> CO <br /> DO NOT WRITE BELOW THIS LINE <br /> a: ` PERMIT CONDITIONS 0 <br /> 1.All calls for inspection shall be made 24 hrs.in advance phone 259-8810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction 1 <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. z <br /> 4, c,ifgib-, i,tiorks di sec- ' - 33 .,2"° " eiN <br /> to pp v,..ri dr 1 sfive I U415 <br /> 0 <br /> limm <br /> Amimmumw <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> C.kl. CCr--/-- and maintenance of the improvement or other right-of-way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved for onstruction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> E7T Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> 259-8810CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: <br /> PROJECT OVER 90 DAYS DURATION. <br />