Laserfiche WebLink
Date 10 -Z- --0( <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />NI a✓ l I �� Nye -4-7 Z Z - 33 fd EV9 �C-tt <br />Owner <br />Public works Pe,,l a I 3 6 Z— <br />Bldg Dept. a <br />Public Works Fee <br />Total Fee S <br />Less ApPI. Fee Paid S <br />Balance Due S J0 <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />Project Address (if known) <br />A L-Ee <br />r; <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <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 • Show measurements <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 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 1-800-424-5555 <br />g. ��indod"e- �t✓-aM c�r�Lre\vdt.Leh®y�vl£.'�r� Sl'1r311 vOO�, <br />iM��%ct, c�Cl 101,,1-tom (�1�O��Ve/r�'�1'e`�'S� c��1c Sft�ll lam. <br />Lz, ci ✓ we t 'I pow <br />�o. �vic+�l� v{ New d.f;�cwa�s bl�aL� r�a1 cxeec, <br />�v;dtho�ex;-s-�""11 <br />4 l <br />App ved for Constr lion <br />Date <br />3- 3-pL <br />FINAL INSPECTION <br />Approved as Constructed <br />Date <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 269-8810 <br />u-t f,, " (- r-iPVrtn tl.�. <br />W <br />z <br />O <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 />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 />City and to replace public property damaged thereby. <br />Signature ppllcant L ^-��v — /�—y 9� <br />D <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED A'JD THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />