Laserfiche WebLink
r <br /> 7//f 7 Q � II- <br /> Date '/ / Z Public Works Permit# ( �'`/2 7 <br /> / Application For Bldg.Dept.# <br /> PUBLIC WORKS PERMIT Publc orrkkssFee $ <br /> Less Appl.Fee Paid $ <br /> Balance Due $ =20 <br /> 0o <br /> Print or Type Only <br /> 002-: 22 VO/88.3/ <br /> sqftAIR_W QuMCM 51&- S EST 4 3 La- L,T)5Li5 <br /> Owner Mailing Address City Zip Phone <br /> S SE-- 5 9t-bo 0 ..-.. <br /> 41,q&A,.) c-. G.ZE2SZ..<-k.Z-V- <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work _C,_jr r' S 6?1 <br /> 11 .11. <br /> v <br /> Project Address(if known) -3—' 7- ,sue e u`ec.-J . limn <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: mom <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 gradin_g,ctlanggs <br /> • Existing and proposed utilities • Show measurements - - - <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 /> /, 5YC 6 & Locafed per altac%ed dP4tu' j <br /> Jr. 0 <br /> /fee,o /0‘ALic S -reef S C'eah all- 4LC fimeS <br /> 6, Do not do cin LGn Q(oh N0ti7/I ro LLiric Ilm. <br /> Lu/fMi%) 20 flrQ,nacc. eQsCn <br /> z�,ek,/ <br /> 7, /-r'ovl cJe G1-7 7 lnecess4 vy e-osioh h <br /> Cobro L- eiS O <br /> dik-eded b y/-f/ie Po 6L(4Joi-,Es /r)s'.ec/o r . 0. <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 /> I expenses, or causes of action that may arise because of installation <br /> .9 --"V. (42 <br /> 9 T�92 and maintenance of the improvement or other right-of-way use hereto <br /> Approved for Construct' Date applied for and further agrees to remove same upon notice from the <br /> pp City a. to replace public property damaged thereby. <br /> FINAL INSPECTION Date Ld A SA f l ' `, <br /> f - ( '.49Z <br /> Approved as Constructed „nature of Applicant Date <br /> SP, PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ,:, PUBLIC200 CedarRKSet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> e., Everett,WA 98201 <br /> tree BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />