Laserfiche WebLink
r <br /> � <br /> Application For j <br /> � PUBLIC WORKS PERMIT °aSe--�=�8='"',7 <br /> PUBLIC WORKS DEPARTMENT Public Works Permil�1 ��—� <br /> 3200 Cedar.'heet <br /> Everett,WA 98201 259-8810 Building Pertnit N — , <br /> TYPE OR PRINT ONLY Public Works Fee$ <br /> / f0�� ! <br /> _ n� 4zs 6q.� - g3/ 7 <br /> JG�Jd..r� 1:,,�P �J/D�/1�t & ST C�/' sIX7 c�L P�c� <br /> wner ai ing Address City Zip Phone <br /> qPP�iCyn��r Mailing Address City Zip Phone <br /> Describe Proposed Work ��� C W <br /> �.� o 0 3 F"' <br /> � <br /> � <br /> PROJECT ADDRESS (if known) � L 2� �p�"�(�6�l�� 'i2�• � <br /> Attach lour(4�copies of plans lor proposed work-Draw to scale and note the following if a licable: O <br /> •Property Lines 'Outline and dimensiors of all existing and proposed structures on ihe lot •Existing and proposed utilities <br /> •Cenlerline of streel •Indicate North •Show any proposed grading changes •Show measurements � <br /> i <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: <br /> 1. All calls for inspection shall be made 24 hours in advance-phone 259-8810. O <br /> 2. All work shall be performed in accordance wiih this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Cali Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555• H <br /> � �.�✓ c�,,.�aroi,.a�r ��.,� �7'�� 7''/�-97 � <br /> // <br /> a � <br /> 47-21-97 9:33AM <br /> N 97226 <br /> OT}1ER 200.00 <br /> OTF#R 100.00 <br /> OTFIQ2 165.00 <br /> TOTAL 465.00 <br /> GHEFG 465.00 <br /> A OR1050 <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> /' The undersigned owner/applicant hereby agrees to holtl and save harmless <br /> the City of Everetl from any and all claims tor damages,costs,expenses,or <br /> Date causes ol action that may arise because of installation and maintenance ot <br /> p v df rCa tru i n theimprovementorothernght-of-wayuseheretoappliedforandlurtheragrees <br /> / So remove same upon notice from tha Ciry and to replace public propeM <br /> 1 �7 da aged thereby <br /> AL PECTION Date 'j � �7_ iJI.C/ <br /> Approved as Constructecl � � �• t <br /> Signature of App i t Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THERFAFfER IS TO BE DILIGENRY PURSUEO TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Pfl0.1ECT OVER 90 DAYS DURATION. <br />