415 OLYMPIC BLVD 2022-09-22 - Laserfiche WebLink

"�9 XV43 Date �. �. � (// 5a�,-, � Public Works Permit# r Application For / V (/ Bldg.Dept.rt PUBLIC WORKS ■ ERMi< Public lictal Works sFee $ e A- - Less Appl.Fee Paid $ """�'�r- Balance Due $ Print or Type Only p I1 e Ke.tJ i i. (3, ,f1 c n 0 6, F. 0; t,.-) R2 d o 0 ,�c,, t`¢}" 7 S z o 3 3/-gas) i( Owner Mailing Address it;; ;;. Zip Phone IA, 4-KeloiA. Ed*" ._ Applicant Mailing Address City Zip Phone Describe Proposed Work filoge os.. Ar ,A.. O rt 044„r t ot esk r 1/reJC £O0 4�lr)a--•f�t c. 8/.J+t, Et,L7 G `i r. .� eir" �r r` r 1 w 4d 4.r .u�^ e'? (e ... 7,` r f MIIIMIIIIIIMININ • ,OSc /y / /� Project Address(if known) 4»r--- �:?4` + 4/5 �`///(_. 5-o.t limin. Attach four(4) copies of plans-for proposed work- Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North Cn proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements CO DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS 0 1.All calls for inspection shall be made 24 hrs.in advance- phone 259-8810. 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction rj Standards and Specifications. 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. z S t . ,. 11,,)" t l"00 ' .; t (e t, t ^i or S ,A, 0 f 0 r f,/e"� .. ,!L.,al,if,6..f GAL ,C.fi:c:.Z.r ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, costs, r expenses. or causes of action that may arise because of installation o i8 w- 5 cci 1 and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the Approved for nstruction Date City and to replace public property damaged thereby. ,.-; �7 � FINAL INSPECTION Date 166'`'''' . A"1.7t-"""' -1-----416-44 • Approved as Constructed Signature of Applicant Date PUBLIC WORKS DEPARTMENT f WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN ® 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE ii ``" Everett,WA 98201 Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.