Laserfiche WebLink
.Ti � � •- t• - ;' <br />Date ''�"��5�0 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />[:�l <br />ng <br />Pubi¢ N'mhs Pcrm�t a —�^ /` � <br />G�T(C`, <br />Bltlq. Deo�- � _i! ' <br />PuhPc WmFs Fce <br />Total Fee S — <br />LessAO�� Fee Pai� $ �DOO <br />Balance Ooe .� _ <br />W/a �I�SC��O �� <br />Alailing Address Ciry Zip Phone <br />Prolec� Address (if known) _ /J�� ��%J� � =� � <br />Attach (o�r (4) copies ot zlans foi proposed work - Draw to scale and note the tollowing as applicable: <br />• Pruperty Lines • Centerline of street <br />• Outline and dimensions �' all existing and • Indicate North <br />proposeo struclures on the lot • Show any proposed grading changes <br />• Exi�ting and proposeJ utilities • 9how measuremenls <br />PERMIT CONDITIONS <br />1. All calls for irspection ;hall be made 24 hrs. in advance • phone 2$9•881(�. <br />2. All work shall be perforrt�nd in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-2300-424-5555. <br />S� I4SYqGL fi Tf/P,E %S' � C9TC'f/B9.Si.r/ /.v �n^,�:.t. iti� �i.�'�y <br />�,e ,�'%AN09e0 �yo2, I.v,SilqCC Ft0lJ�iy,p��{�rlATE2AL <br />cS'�i�A��9TmR /��� C/Tf/ S>r?NO,,o.?p r9�/n_ AN� CONN.ECT <br />ja .SiOB S<7.vE2 G✓i�iv h��.u. 6" Din' �''iPE. <br />� PfiUB 1'f�.P.ei.-r/lr AR',EA l.�JiTs/ o2•�pF CGASS d� �9S�h',9C7' <br />Du.�� 5"' o�f' C.eus.�'a � Sri/rF�c.•✓.:- Ta<' C'Oli��', <br />� Af'PuC9�/T /�'i.'9f/ �".r/cGUv� /�LG�f/ /.t� P/Jvin/lr A•r/D .T�/ST9c( .QEQcy,eEo <br />C9TcN �'Si.� /•✓ /l�.�Ey iP9r.sl�c Tiii9•v i.v �i9,e,ri.r/� A,e�1�_ <br />W <br />� <br />� <br />Z <br />O I' <br />% c.$�iO� S87<lE,� hHIST .96 /yii.�iin�/mJ �o ��,DiA �oin B�/iLDi.UG Tu n7r9i� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersiqned owner/applicanl hereby agrees to hold and save harm- <br />less the City ot Everetl I�om any and all claims for damages, costs, <br />/J expenses, or causes ot action Ihat may arise because ot ins!allation <br />•�� p�Z 5/ 2l !R and maintenance of ihe improvemenl or other righPOFway use hereto <br />�'= applied fPr and lur�her agrecs to remove same upon cotice irom the <br />ns��� rS ,—= � Date City_aP�io replace puUlic pruNarty dama9ed ihereby. <br />��O <br />.� <br />�INAL`INSPECTION / <br />Approved as Constructed <br />everett PJBLIC WORKS QEPARTIdENT <br />� 3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone: 259�8810 <br />'3f�ureol,4pplicapY/ � � � � " Date <br />K AUTHORIZ�JBY THIS PEFMIT MUST BE STARTED WITHIN <br />8 DAYS OF DAitj PERMIT IS ISSUED AND THEREAFTER IS TO � <br />DILIGENTLY PURSU[D TO COMPLETION. THIS PERMIT MAY BE . <br />CANCELI.ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS �, <br />PROJECT OVER 90 DAYS DURATION. �� <br />