Laserfiche WebLink
14' <br /> Date ;OKA Qi '0 Public Works Permit# 067 13 <br /> 1 f <br /> Application For Bldg.Dept.# <br /> PUBLIC WORKS PERMIT Public Works Fee <br /> Total Fee $ <br /> Less Appl.Fee Paid $ <br /> Balance Due $ <br /> Print or Type Only <br /> -SA rn 13(A3ley 20 SAN -i vet-el <br /> iiv Z.- ) 9-92-01 <br /> 6 - 7 ' — <br /> Owner Mailing Address City Zip Pho n CA <br /> • <br /> Applicant Mailing Address City Zip Phone <br /> , <br /> ,,,_ .., <br /> A., / i i <br /> et,a. :..,ref/fie (7,-, 1 4(.1(1, Id IA.#1">e" r-,-).- i 0 <br /> Describe Proposed Work • . .,... , ' <br /> 4if <br /> -7/ 4/ <br /> I , <br /> A/9. A. # Vi. ( iNvi1/4.4. i.A 111 ""ite <br /> wassismsmsta <br /> LIU <br /> Project Address(if known) <br /> lui <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: ImiN <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North Cl) <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> CO <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS 0 <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 111, <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. <br /> z <br /> 0 <br /> I- <br /> Cl) <br /> 0 <br /> Om <br /> ...... .... <br /> ; 1)7 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 /> expenses, or causes of action that may arise because of installation <br /> 1,, 1.4e. right-of-way/korai /6, tro3 and maintenance of the improvement or other use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> 4---;:e)14(1411Appr ed for Construction Date <br /> .. City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> •Si!, PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street <br /> BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> •:,,o; Everett,WA 98201 <br /> CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 <br /> PROJECT OVER 90 DAYS DURATION. <br />