Laserfiche WebLink
(I '1 <br />Date/ { Public Works Permit < 213 / <br />, + <br />Application For Bid,Bell <br />PUBLIC WORKS PERMIT Q Public Works FeeTOM <br />— <br />ToFee S <br />O <br />p less Aoll. Fee PaN 5 <br />aalnnce Bue $ —� <br />Print or Type Only c b Lru; <br />002-322510/7,93/ <br />A rl <br />Ownei Madinu Andress Cpp� $ Pi •• 7-m. Fhnne <br />/ O UJ <br />o U <br />Applicant M: dmq Address City Zio Phone <br />Describe Proposed Work ✓ '•'�Y=���1L��EG�--�- <br />Project Address (if known) <br />Attach four (4) copies of plans.fol 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. 00 <br />3, Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />T. 7 7enCC' o,,) Per <br />b.h ppr L,?rr <br />�O z <br />Approved for Const ction <br />FINAL INSPECTION <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />/?c-• <br />W <br />N <br />ca <br />O <br />.Z * <br />.0 , <br />N <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 />Cdy and o ro <br />replace ublic pertrr�amaged thereby. <br />Date /-- "'-' u "� —" Date <br />Signs le of A licant <br />S PERMIT MUST BE STARTED <br />80IN <br />RDAYS I OF DATED PERtyBY ' IS ISSUED AND THEREAFTER ISTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />iCANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />