Laserfiche WebLink
Date _�C'_( � _,.. �,..m <br /> :v,�,�s �i. <br /> Applica6on For [.a!�.�Drm • -- --_ <br /> PUBLIC WORKS PERMIT ������,��,�•Fe� <br /> TotalFae 5 <br /> Leaa�o�I.feePaia S <br /> Print or Type Only e,�a��eo�a 5 <br /> 'x�C,.�� Robert Buse 3G00 Smith Avenue Everett, WA 9820� 252-7179 <br /> (x� [q Owner MaJing Atltlress Gty Zip Phone <br /> > H <br /> C � H <br /> � y y Charlic Betts - Everett Gospel Plission P.O. Box 423 Everett WA 9820� 252-4776 <br /> x> Apphcant Mading Address City Zip Phone <br /> HXH <br /> '� n We would like to remove a roxima[el 480 cubic yards of soil from <br /> O x O Describe Proposed Work PP Y _ <br /> '�1 �+ A1 3711 Smith Avenue (Puturc new Gospel Mission Building) , and place it along the bank <br /> VJ H <br /> �x�" adjacent to Burling Northern Railway. We agree to dress and seed the bank upon comp- <br /> [� p�J W <br /> H C letion. <br /> � Cn+1 O Project Atltlress lil knownl 3711 Smith Avenue � <br /> InY (�] <br /> z�„� Attach lour(4�copies ol plans for proPosed wo�h-Draw lo scale and note Ihe lolluwing as appli[able: � <br /> Y H x • Properry Lines • Cenlerline ol;treel /w <br /> t' • Outline and dimensions of all exis�ing and • Indicale Nor�h V, <br /> Hy <br /> �y y H proposed slructure5 on the iot • Show any propoSeA 9rad�ng chanyes <br /> ��y • Eaisling and proposed utilities • Show measurements � <br /> � �� DO NOT WRITE BELOW THIS LINE O <br /> H Cn <br /> H O C/� PERMITCONDITIONS <br /> 1.All calls lor inspection shall be made 24 hrs.in ativance-phone 259•8810. � <br /> 2.All work shall be pedormed in accortlance with Nis permit and current City ol Everett Design antl Consiruction <br /> �' � Standards antl Specilica�ionS <br /> � �� 3.Call Location Undergrountl Serv� e 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> � `S� �K�+ti-�2 • <br /> � �- ��'�''� O <br /> i "�� wts,e,. <br /> s�-h <br /> � y_�� a r;��;'��,...r s;�� , 3 -�-�° H <br /> i -- �� � V) <br /> � , O <br /> ��� �,—�n. r � <br /> =1_' P•S� ��I�, �S�SN���'G�MENTOFCONDITION <br /> �� The undersigned owner/applicant hereby agrees to hold nd save haim� <br /> less t�e City of Everett Irom any and all claims for tlamages. cosis. <br /> expenses, or causes ol aztion ihat may arise 6ecause ol installation <br /> 1_1�' antl mainlenance ol ihe improvement or other righ4of�way use hereto <br /> � � Approved for C �struction Date applied tor and lurther agrees to remove same upon nou[e Irom ihe <br /> Ciry and to replace public pronerty damaged Ihereby. <br /> FINAL INSPEC710N Date <br /> ApOrovetl as Consiructed Signature of Appli[ant �ate <br /> PUBLICWORKSDEPARTMENT �NORK AUTHORIZED BV THIS PERMIT MUST BE STARTEO WITHIN <br /> 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 70 <br /> � Everetl WA 98207 BE DILIGENTL� PUFSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phone:259-88i0 CANCEILED BYTHE CITV UPON ANV STOPPAGE OF WORK ON 7H15 <br /> PROJECT OVER 90 DAYS DURATION. <br />