Laserfiche WebLink
Date-3 - <br />APid1. lion ror <br />PUBLIC WORK, S PERMIT <br />Print or Type Only <br />Melling Address Clly <br />Owner <br />M <br />Public work. P�xmn�./��.-------- <br />aida D"t & M-4 <br />/'/- -T <br />PublK Work. Foe { <br />Total Fee <br />— <br />Lan Awl, Foe Paid <br />Balance Due { <br />•� <br />—Zip Phonu <br />Zip <br />Applicant Mailing Address <br />�L <br />Describe Proposed Work <br />J 6153 ) 301 <br />44 E. FOE <br />Pro!oct Address (if known) _.[s�•1--y—t-- <br />Attarh four (4) copies of plan^, 1. Froposed work. Draw to scale and note t Centorline DI sirIg us treet` able: <br />• Property Lines • Indicate North <br />• Outline and dimensions of all existing and • Show any proposed grading changes <br />proposed structures or the lot • Show measurements <br />• Existing and proposed utilltler. <br />PERMIT CONDITIONS <br />T. All calla for Inspection shell be made 24 hr& in advance • phone 259.8815. <br />2. All work shall bo performed in accordance with this pnrmit and current City of Everr •I Design and Construction <br />Standards and Specllicallore <br />3. Call Location Underground :'ervice 48 hrs. before you dig. TOLL FREE NUM4EF ' •000.42A•555 <br />for <br />Date <br />Approved as Constructed <br />i <br />PUBLIC WORKS D <br />Ever tt, WA Street <br />Everett, WA 98201 <br />WORKS <br />Phone: 259.8815 <br />z <br />0 <br />IONICs <br />�J� <br />0 <br />an <br />Ar,KNOWLEDGEMENT Ot� CONDITIONS <br />The unuersigned owneriappocant hereby agrees to hold and save harm- <br />Everettless the City of any and <br />all claims for <br />expenses, or causes of action that may arise because eofainstallation <br />and maintenance of the Improvement or other right-of•way use hereto <br />appl for end further agrees to remove some upon notice from fire <br />Cit an to replace r.blic oparty da ad thereby. yam\ <br />Sig Ira c of APPII ant <br />WOHK TU-HORIZED 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 <br />ANY <br />STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />