Laserfiche WebLink
� <br /> I <br /> � <br /> � 7- 2fo- � <br /> Date ,O Pupl¢Works Prrmll r <br /> Application For em�.ocai.. <br /> PUBLIC WORKS PERMIT PublicWorMsfee — <br /> Total Fer $ <br /> LeSSFppI FeePal� $ <br /> Print or Type Only Balance0ue s <br /> /�Q�rv�( /19. ��ycir� /0,30 S'9'�^ ��. sK! E�/EA'��1T 98'zo3 ZS2 -3S�BZ <br /> Owner Mailing Address City Zip Phone <br /> f�Q�ric�C /J�. BDCA�T /03o y9'4TL. SY✓. EVc��CETT' 98Zo3 252- 35�82 <br /> Applicanl Mailinc�Address Ci�y Zip Phone <br /> i/ <br /> Describe P�oposed Work y1 /�/�/� /eG"i(/Gr O�t/ �/GiYT O�l��i�Y f�GO.tf4 <br /> SE.4 f�si.2sT R✓� <br /> �"� W <br /> Prolect Address lit known) 1Q36 S�9'y' PL . �.sy, EyE.PETr i✓, .t0 � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline ot sireel � <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 • SFow measurements � <br /> DO NOT WRITE BELOW THIS LINL O <br /> PERMIT CONDITIC NS <br /> 1.All calls for inspe:tion shall be made 24 hrs.in advance-phone 259-881 O. � <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-$00•424-5555. � <br /> �� ����� O <br /> _L�--.-.,�;� �� - �' <br /> �=G i-���.'�il�14> �J�'�'W1�l�l EY'.$ O�L�S�CYJ ♦R '.. <br /> ��� <br /> �c��n'�, 2�� �S M�'r��,F�Tta� c-o2- O <br /> �� ,-��� �.� a <br /> ���.N��r�--� <br /> ACKNOWLEDGEMENT OF CONDITIONS � <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everetl from any and all claims for damages, costs. <br /> expenses, or causes ol 2ction ihat may arise because ol ins�allation <br /> and maintenance of the improvement or other right-o(-way use hereto <br /> applied for and further agrees to remove same upon notice irom ihc <br /> Approved for Consiruction Date Ciry and�o replace public property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature of Applican� Date <br /> everett PUBLIC WORKS DEPAR7MENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98207 BE DILIGENTLY PURSUED TU COMPLETION. THIS PERMIT MAV B[ <br /> Phone:259-B810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />