Laserfiche WebLink
Date N <br />SPAL/r � / <br />r iLA' <br />Public Works Permit <br />25:0 1 <br />d <br />Application For <br />/9dSr <br />Bldg Dept, <br />PUBLIC <br />WORKS <br />PERMIT <br />Y11(o`G� <br />Public Works Fee <br />Total Fee $ <br />Less Appl. Fee Paid $ — <br />Print or Type Only a <br />$ g <br />o <br />g $ <br />I Balance Due $zn— <br />tr'os,ow 0or-,t4 <br />01 mNi�MrtDa <br />yN.+ <br />o <br />o <br />Lynnu <br />cud <br />9Sa7 M-&S-0 <br />Owner <br />Wi N MatMat6l r <br />W— if W <br />City <br />Zip Phone <br />A. -� o <br />Wm2�!e?'m <br />Applicant <br />Mailing Address <br />Describe Proposed Work I I e w S 1 R <br />Project Address (if known) <br />City Zip <br />10 - z -7-11+ >-ve <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable <br />• Property Lines <br />• Centerline of street <br />• Cutline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />NE <br />Phone <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 witt 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 />w <br />O <br />a <br />O <br />a <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 />expenses, or causes of action that may arise because of installation <br />•+ O ,A/1 �� ^12_ a and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />Approved for ConstW IT Date City and to replace cubic property damaged ereby. <br />FINAL INSPECTION Date <br />Approved as Constructed Signature of Applicant' Date <br />everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />3200 Cedar Street 180 DAYS DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY <br />Y PURSJED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY 1'TOPPAGE OF WORK ON THIS <br />Phone: 259-8810 PROJECT OVER 90 DAYS DURATION. <br />