Laserfiche WebLink
Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />Protect Address (if known! <br />Plan Check No: <br />Applicat.Date: <br />Job Address: <br />Owner: <br />Tenant: <br />Proposed Use: <br />Desc. of Work: <br />NEW DETACHED <br />B 45041 <br />07626/94 <br />17 6 62ND ST <br />KARLSON KNUT <br />SFR/GARAGE <br />GARAGE <br />Papal works Puma <br />Bldg pact a <br />Pucac Works Fee <br />Total Fee S — <br />Lets Appr Fee Pod S <br />Balance pie S <br />SEPA <br />Phone <br />Phone <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ By <br />Attach lour 141 copes of plans to, proposed work Draw. to +nakil wa note pTa rollowmg as aD4hnabie <br />• property Lines <br />• Centerline rf street <br />• Outline 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 />INE <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hisin 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 />.UBLIC WORKS PERMIT <br />NOT REQUIRED <br />-1 y 6 <br />IATE Q� <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />W7200 Cedar Street <br />Everett, WA 98201 <br />Dnn'. 95Q-HRIn <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />O <br />Z <br />O <br />The undersigned owner/applicant hereby agrees to hold and sa,:e 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 nghfol-way use herelo <br />appl nd for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />re of Applicant <br />Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT 15 ISSUED AND THEREAFTER S TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />ono IF(-T 11VFR on DAYS DURATION. <br />