Laserfiche WebLink
8 5 <br />Date C•t L,z[JJ I Public Works Permit • L7 J _ ¢' n <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />SN <br />Applicant <br />A <br />'p.0.yx)D . Rzto <br />Mailing Address <br />Bldg, Dept.. <br />Noll: Work. Fee S Total Fee <br />Lea. APPI. Fce Paid S /_ <br />Balance Due <br />City Zip Phone <br />ri.eTT-- `149 - (OVI <br />y Zip <br />Describe Proposed Work ✓ cDA%4_9 [r 5Lyirei to &4� LEl{ ( LG4/ iC 141 <br />Project Address (if known) <br />S <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424.5555. <br />All- LL CR/r/-� G�% S F.E' SE/�JE� SE�z v: C'e <br />% /. Cc90Ae-C .1'EcFaSE <br />,2, Ci1.eN.4G/E PQ,e,L//A.rG LO% <br />"vSr f/.d ✓E A C t'. CovEoe 1 /✓.SrAZee-Z) 0 v iflCi>> <br />AAID AaruSrE/D Ta G.ea�F. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />n <br />W <br />M <br />0 <br />n <br />z <br />0 <br />rr� <br />0 <br />0 <br />a <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 />,� �� il✓ 3 ��_ �S. 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 />ion ® Date City and to replace public property damaged thereby. <br />a '� 11 0u)1 5 <br />'FTN LINSPECTION Date: ��Gµ OOi.a tSCO(✓L, 5��I L <br />Approved as Constructed Signature of Applicant Date <br />everett 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 />Everett, WA 96201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Phone: 2598815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />