Laserfiche WebLink
Date�l�l- N"ne,:wo�ks a�� ��e =`7�c�-�— ��O <br /> � � BICg.Dept.r �/ — <br /> Application For ' <br /> R'UE3LIC VI�OF�KS PERMIT PubiicWOMSFee <br /> to�ai Feo S— <br /> , Lrss ADO�.Feo Paitl $ �-7r— <br /> 9alance�ue PJ <br /> Print or Type Only <br /> _� � d�o - � �" �'� ��-� �s�-6�.�9 <br /> Owner Mailing Address City Zip Phone <br /> �� ��� <br /> Ap cant Mailmg Address City Zip Phone <br /> Describe Proposer!Work <br /> � <br /> — � <br /> Project Address lit knor n) _. /2d33—�� .D.L� S.E, _ � <br /> Atlach four(4) copies of plans for proposed work- Draw to scale 2nd note the following as applicable: � <br /> • Property Lines o Centerline of st aet ♦A <br /> • Outline antl dimensions of all existing and i Indicat��North V� <br /> I proposed structures on ihe lot s Show any proposed grading changes <br /> • Existing and Froposed utilities O Show measurements � <br /> DO NOT WRITE BELOW THIS LINF O <br /> PERIdIT CONDiTIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advnnce- phone 259•881 5. � <br /> 2. All work shal: be perlormed in accordance wi�h lhis permil and current City of Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> y �Oitlit/�=C` JO�uAIS�'c-+c�T.s Tc� O.P9ii+/�9(2�� S�.SiE� - � <br /> .� ,e'€A,a.� ,c"�a�Ac-E" 9tiy d�.�,�:Ei✓ �'�°�3� GvrTc=� � S�OEsJR�,�, <br /> / V,(�/'Oc: LoT So •9s .vor 7"0 7MPy�•r S�r,�,���v����+!% Gn.%,� /�/� <br /> i/f//i>f,' •Qf�in//.�/NT��' ,Z%.'.cl o�., V♦ <br /> O <br /> �ti <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby ac�rees to hold and save harm� <br /> !ess the City ol Everett Irom any and all claims for damages, costs, <br /> , /� � � expenses, or causes of action Ihal may arise because of ins�allalion <br /> �� �{��=��V /��-/ and main�enance of Ihe improvement or other right�ohway use iiereto <br /> %� F�_,.-epplietl\for and turiher ac�rees to remove same upon notica from ;he <br /> .qpproved foi�Const u ion ` ' �D�te � City and to replace public property damaged thereby. <br /> � / / <br /> v. �.'� v 1 ��� �� . / <br /> FINAL INSPECTION� �- ` Dale � ���� /�r / / ��r='�.� ��---�.�� <br /> Approved as ConsiructeJ � � �`Signature of� Appl— ic5nt� ,.,/'1J � Date � <br /> PUBLIC WORKS DEP:�9TMENT � WORK AUTF'�.URI2ED BY �n)S PERMIT MUST BE STARTED WITHIN <br /> everet[ � 180 DAYS OF DATE PER1Jf1T IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar SirePt BE DILIGENTLY PURSUEU TO COMPLETION.THIS PERMIT MAY BE <br /> Evere�t,WA 93201 CANCELLEG B'/Ti1E CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone� 259�8815 PROJECT OVE{ 90 DAYS DURATION. <br />