Laserfiche WebLink
Date_��/ <br /> a�encwo�keva�mn. 91 , � <br /> Application For <br /> (�J �7Q5�1 K� �f� BitlO OeaL�� <br /> PUBLIC WORKS PERMIT � - � �Y�` PubTotaFoeFee s <br /> Lesa Pppl Foe Paia S <br /> 9alanco Oue S Z� <br /> Print or Type Only <br /> n � ���v A() Ro�[ $_�D.� t�VP/A�——,��� ZO FJ -�.3`�5��� <br /> r Q r I n <br /> ��e� Mailing Adtlress City Zip Phone <br /> 1 <br /> �ic� Madmg Address Gty LP Phono � <br /> w, : <br /> Descrihe Proposed Work ���� / r n�/e��J/ � r� (d" " �f�4� L�K � <br /> W <br /> Projec�Address(il knawn� _ �� � � — ��� 2 � ���' �L�A�(� _ ~ <br /> Attach four�4�copies of plans br pmpnsed work- Draw to sca�e and note the tollowing as applicable: � <br /> • Pwperty Lines • Centerline ol slreet � <br /> • Outline and dimensions nf all existing and • Indicate North <br /> proposed structures on ihe lot • Show any proposed gradinc7 changes <br /> • Ezisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All cal�s tor irs pecHon shall be mude 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall Ge pedormed in accordance with ihis permit and current Ci�y ol Everett Design and Constmction <br /> Standerds end Specilica�ions. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> OS/�/9: 9�20RM OOORH7047 <br /> / O <br /> k0�026885 <br /> FLDG 5464.00 <br /> rLEG 545.00 � <br /> MECH 59�.00 <br /> G SRCN 44.50 'w <br /> DFVW'� �20.00 V J <br /> n000^cd�71 O <br /> SEWER 530.00 <br /> 1171-5 565�.(H) <br /> q00007237 �� <br /> WATER s130.00 � <br /> CHECf; 51433.50 <br /> ACKNOWLEDGEMENT OF COIJDITIONS <br /> The undersigned owner/appliwnt hereby a9rees to hold and save harm- <br /> �� less lhe Ciry ol EvereU irom any and all claims lor damages. cost�, <br /> expenses, or causes of action ihat may ari<p because oi installation <br /> ��A�1 ��`��_ 4_3��_91 and maintenance ot ihe improvement or othar righ4ot-way use hereto <br /> applied for and furiher agrees to remove same upon notice irom ihe <br /> Approved lor Consiru�n �a1e City and to replace public properly damaged thereby. <br /> lJt��'� /O-//-y% /�,� ��G—// <br /> FINAL INSPECTION �a�e Dalc <br /> Approved as Constructed Signzture of A plicanl <br /> WOR{ AUTHORIZED 3Y THIS PERMII" MUST BE STARTED WITHIN <br /> �,�� PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Codar Street BE DILIGENTLY PIIRSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everetl WA 98201 CANCELLED BY THE CITY UPON AN�STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DUr7ATl0'J. <br />