Laserfiche WebLink
Date Public Works Permit# / / 6--v-5-- <br /> Ill Application For Bldg.Dept.* ` , - n�y ec) <br /> ci <br /> PU,sv LIC WORKS PERMIT Public Works Fee f' <br /> Total Fee $ <br /> ral <br /> ".J Less Appl.Fee Paid $ <br /> CI J5`y-00 <br /> Print or Type OnI p Balance Due $ <br /> - nn0 - ' --22sia -004- /7-83/ <br /> — tf,Ate ta <br /> Own-r o*',.. re:, Mailing Address City Zip Phone 261 - a <br /> wollia A01 or 0 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work <br /> '"" 1. ' • <br /> W <br /> Project Address(if known) Z7 b1tie 11 <br /> — <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: mos <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 /> CCI <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <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 <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. <br /> 0 ez-c lx-;C2 v 0 0,,, 6' P/ i <br /> I- <br /> Cl) <br /> 0 <br /> a <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 /> fil•Xer27— -- 6/2 expenses, or causes of action that may arise because of installation <br /> 9> and mainte ante of the improvement or other right-of-way use hereto <br /> applied for'and further agre s to remove same upon notice from the <br /> Approved fouction Date City and t, replace public op ty dam d thereby. <br /> FINAL INSPECTION Date ( �-1 �/ <br /> Approved as Constructed -.ig ature of Ap i ant ate. <br /> PUBLIC WORKS DEPARTMENT WORK AUT RIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLIC d 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 00Cedar <br /> 9 Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:EverettWA 259-8810201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />