Laserfiche WebLink
� �' -_s -� <br /> �8te p��,��p� —• PUEIic Wo�xe Pomn♦ <br /> ��n.�•Tw <br /> ApDlication ror emo.oepi.. 91/27542 <br /> PUBLIC WORKS PERMIT PubTol�Fe°,�.° � <br /> lesa Appl.Fee PaiE S <br /> Baiance Due S <br /> Print or Type Only <br /> Kansas Wolford 2201 Adams Ave �rerett 98203 355-5810 <br /> Owner MeiNng Address City Zip Phone <br /> Owner <br /> Applicant Mailing Address City Zip Phone <br /> Desc�ibe Proposed Work 1ldditiaal & re—roof — SFR _ <br /> W <br /> Project Address(if known) �n7 nA a�+ � <br /> Attac�fou�(4)copies ot Glans for proposed work-Drew to scale and note the following�s applicable: � <br /> • Property Lines • Cente�line of street � <br /> •Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any prop�sed grading changes <br /> • Existing and pro!wsed utilities • Show measu.�ements � <br /> DO NOT WRITE BELOW THIS LIN O <br /> PERMITCONDITIONS � <br /> t.A11 calls tor inapection s�a11 be matle 24 hrs.in ativance-phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and c�rrent City of Everett DeSign end Construction <br /> Stantlards and Specifications <br /> 3.Call Location Underground Service 48 hrs before you dig.TOLL FREE NUMBER 1•800�4245555. � � <br /> j � <br /> ��//� U1�/�"..'_ /!1v[ ��eG?uius. , ., O <br /> 0 <br /> � I i . � <br /> � I <br /> 8 22-9/ � <br /> O <br /> a <br /> ACKNOWLEDGEN=NT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agreas to hold an0 save harm- <br /> less the City of EvernN from any and all claims for damages. costs. <br /> . exDenses, or causes of action that may arise because of installetion <br /> and maintenance of the improvement or otM1er rig�t-of�way use hereto <br /> applied foi and furthe� a9rees to remove same upon notice from the <br /> Approved fo�Construction Date City and to replace public property damaged ihereby. <br /> FINALINSPECTION Dare — <br /> ApDroved as Constructed Signature of Applicant �?�e <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED B`.' THIS PERMIT MUST BE STARiED WiTH�N <br /> 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Ceder Streat BE DILIGENTLY PURSUEp TO COMPLETIUN. THIS PEFMiT MAV BE <br /> Everett,WA 98201 CANCELLED BV THE CI?V UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVEfi 90 DAVS DUP.ATION. <br />