Laserfiche WebLink
�I �'.-�� �,��� � a T�,3 �� <br /> Date—(-� � PubLc Woiks Permit a { I <br /> i AppliwtionFor eieq.oeo�.= !�� �;�^-> <br /> PUBLI� W�OI��S PERMII' �-�`�' ��r +� 97 ( i-1��x <br />�� PublicWo�ksFee S <br /> Totel Feo <br /> Less A00���ee Paid s 2 0�c <br /> Balancc Due $_ <br /> Print or Type Only <br /> ��-� ����: ���,?q ��'I,-,4-�, ' 1��, ;-�,���r- �ao r asa� � c�,�_ <br /> Owner Mailing Address �� Ci;y Zip Phone <br /> i���77� <br /> Applicant Ma�lin{ Address Jity 2ip Fhone <br /> ! `� / /� <br />� Describe Proposed Work / I�Q,� � r� �,%�`�� �.� �'���'�-\� � � `.l.% <br />��I Prolect Address(if known) ?/��7�t/� ' �-3Y�.Sy_` � � <br /> � <br />� Attach four(4)copias of plans for proposed work� Dra�.v to scale and note lhe fo�lowirg as applicable: � <br />� • Property Lines . • Centerlina of street � <br />{ • Outline and dimensions of all existin9 and • Indicate North <br /> propose�.structures on the lot • Show any proposed grading changes <br /> S • Existiny and proposed utilities • Show measu:ements � <br /> b <br /> �� <br />, DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIOfJS <br /> 1. All calls for inspection sha�' be made 24 hrs. in aclvance- phone 259•8815. � <br /> 2. All work shall be performed in accordance with this oermit and current Ciry of Everett Design and Construction <br /> a'tandards and Specifications. <br />, 3. Call Location Underground Service 48 hrs. belora you dig.TOLL FRCE NUMBER 1-800•424-5555. � <br /> � <br /> � <br /> �/� <br /> \/ <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br />�� The undersigned owner/applicant herPby agroas to hold and save harm- <br /> less the City of Everett irom any and all claims for damages, costs, <br /> expenses, or causes o( action that may arise beceuse of installation <br /> ��� ��.G`;�, 5/V y R' and maintenance of ihe improvement or other right-ol-way use nereto <br /> applied for and further agrees to remove same upon nofice (rom the <br /> Approved for Construction � Date �ily and to replace public property damaged tliereby. <br /> ,����� �=�G-f� �� � � / � ' <br /> FINAL INSPECTION Date ��*-u.—� �' �S ' ;�`f% <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHOHIZED BY THIS PERMIT MUST BE ST.4RTED WITHIN <br /> � 320GCedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND TH=REAFTER IS TO <br /> Everett, WA 98201 BE DILIGENTLY PURSUED TG COMPLETION. THIS PERMIT MAY 6E <br /> Phone: 259�883$-S,j�,Y(� CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK�N THIS <br /> PROJECT OVER 90 DAYS DUFATION. <br />