Laserfiche WebLink
Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Worka Permlt • <br />eieo. oeo�.+ _ <br />PuELc Works— Faa � <br />Tolal Fea $ <br />Laae Ao�t Fee PaiO �+ <br />BabnceDue S <br />Plan Check No: B 43970 SEPA <br />Owner APplicat.Date: 04/O1/94 <br />Job Addreee: 23b4 kADISON Z�P Phune <br />Owner: LACKER STAN <br />PropoaednUee� SINGLE FAMILY RESIDENC� <br />Applicant Deec. of Work: <br />REGABLE CARpORT, RESIDE AND REROOF EXISTING Z�P Phone <br />RES <br />Describe Proposed Work OFFICE SET <br />J08 SET <br />APPROV�D FOR pERMIT: DATE_/_ <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Proper!y Lines <br />• Outline and dimensions of all existing and <br />prOposed structures on the lol <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls for inspeclion shall be made 24 hrs. in advance • phone 259•8810. <br />2. AI� work shall be pedc � med in accordance with ihis permit and current City of Everett Deslgn and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 4P hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />Pl'BLIC WORKS PERMIT <br />NOT R OUIRED <br />BY_ <br />DATE �/ / 9f� <br />Approved for Construction Date <br />F�NAL INSPECTION Date <br />Approved as Construcled <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA 98201 <br />Phnnc 259�AR10 <br />ACKNOWLEUGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />�� <br />� <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the Cily ol Eve�etl Irom any and all claims for damages, costs, <br />expenses, or causes of aclion thal may arise because of installation <br />and maintenance of the improvement or olhei right-obway use hereto <br />applied for anC `urther agrees to remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZFD BY THIS PEFiM1T MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS 70 <br />BE DILIGENTLY PUFiSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY S70PPAGE OF WORK ON THIS <br />,�...� �r.,,�,-�>.,��.,,..� n�� .,rinn� <br />