Laserfiche WebLink
Date / <br />Application For U ly <br />PUBLIC WORKS PER1�K14 DEC 091983 <br />...... ............... <br />Print or Type Only ciTy Of EVERETT <br />l PI° W rks Dept. <br />fl/u/Sf10/71<S�ti�CaI/t <br />Owner Meiling Address City <br />�e �1 <br />Public work. Pam" a Oz <br />Bldg. Dent•_ — <br />Public ke WoFee <br />Total Foe S • O O <br />Len Apot Fee Pam S <br />Balance Due S —;L'o . C <br />Applicant Melling Address City Zip Phone <br />Describe Proposed Work INi%/%!L ,7S r /il/Ar 6-46 C7t--ry/<%Ca: ✓/{y <br />Project Address (if known) 609 -7 oi S. <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: s <br />• Prope.1y Lines • Centerline of street ♦A <br />• Outline and dimensions of all existing and • Indicate North v+ <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed rfitities • Show measurements <br />�aasss�� <br />DO NOT WRIIE BELOW THIS LINE O <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be made 24 hra in advance - phone 259.881 5. ash <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction i <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hra before you dig. TOLL FREE NUMBER ! •800.424.5555. z <br />O <br />0) <br />O <br />am <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm - <br />lees 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-of-way use hereto <br />applied for and further agrees to remove some upon notice from the <br />AVOM—ed to o r c on Date Cil replace pu tic property damaged thereby. <br />�1 1 tee h <br />FINAL INS E 10 Date It <br />Approved as Constructed Sigprilitfure of Applicagif Dale <br />everett PUBLIC WO EPARTMENT RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 1"0 <br />3200 Ceder Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />