Laserfiche WebLink
Date4-47 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner Meiling <br />Applicant <br />Describe Proposed Work <br />Mailing <br />Zip <br />zip <br />Public Wori, PaIMK • <br />Bide DeW a <br />Public Works Fes s <br />Toler Fes <br />— <br />Less APPI Fee Paud 5 <br />solstice No •�� <br />Project Address (if known) �72�- 70 '�Ji pe. s•E — <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 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 259.8815. <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 his. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />S CO2 AJ.E[T' .�Ol-S�=TOf' �e'x�✓.e%f�G?S TO L EA.oE.CS <br />el 0cAw0oQ1*7 <br />(G,. CyJlc•d .�' C�JTF/'- /�eE .•�GJ f ci.rv�c'otEic/, ANy Cu.�l) ¢ <br />tie Sao<s.�rP[C i� v Ovi:.vC. %.Yis CYkJSre"-1�4/ <br />urhW44- ATE ii'Eix 9�E� 1�� p,E �9r7�inCF'n/T <br />for <br />U <br />Approved as Constructed v <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 88201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />O <br />z <br />0 <br />0 <br />a <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-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 Date <br />WORK AUTHORIZED SY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETIUN. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />