Laserfiche WebLink
DateG <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pubbc worts Parmn • <br />Bldg Dept s <br />Pubi¢Works Fee ` <br />Total Fee <br />Lass Apo( Fee Palo <br />Bshr¢e Dw i <br />��— <br />�� PO BoX 59a Lis s725✓6.F/S / SY- 20,21 <br />Owner Melling Address City Zip Phone <br />S9irs< iVX 14ix4ave- <br />Applicant Meiling Address City Zip Phone <br />Describe Froposed Work ef=&&z&e, ee— -,W4/ Si416LC Fil'inic d ic'�rEOE.� " <br />Project Address (if known) /70Z - 7a°l '0z.'re _ <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 dimenalomr. 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 259.8815. <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 lots. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />444tleyw7 /S To .eexle/xE A.vy S1,0ewPz4 G6eeI9 <br />Lie 6&17S< THAT /S ,09M9„�U l)li.C'it/G CO.JST.PLK7�0,4I <br />SiOErJALrt 11 C&e,& ¢ CfUZ%t-`R Aff i1101-J A14F, ( &1VA01*.9GE,0, <br />5; .00/1 7010 Alt.Wrl-av7r To de ea&41 r,' 0 Tv 100AeoveO <br />sys7cM <br />/_07 IS To BE ",,90Eo SO AS Alo7 To 7Ih7O.Ver <br />AoT��"�i✓trr LOT-f• <br />Approved for Con ruction —� Date <br />FINAL INSPECTION Date <br />Approved as Constructed ' <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />TV <br />t <br />ZI <br />O <br />O <br />an <br />The undersigned owner/applicant heroby agrees to hold and save harm- <br />less the City of Everett from any a id 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•ol•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 of Applicant ate <br />V,OHK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND 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 />