Laserfiche WebLink
� �WPlication For <br /> PUBLIC WORKS PERMIT °a'a '�1�97 <br /> PUBLIC WORKS DEPARTMENT Public Works PermH N � ZI S <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8810 2 � Bullding Pertnit M 55793 <br /> � 3�OSTING oc��-- — <br /> TYPE OR PRINT ONLY Public Works Fee 3 <br /> SELCO DEVELOPMENT PO BOX 1524 SNOHOMISH WA 98291 668-7763 <br /> Owner Mailing Address City • Zip Phone <br /> JON SELIN 742-1515 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work NEW HOUSE ■ ■ ■ <br /> W <br /> _ o�-u-� io:zoan � <br /> 232 eut�i�s �o.w — <br /> PROJECTADDRESS(if known) PINE ST I �Q- 7 � <br /> Atlach four(4)copies of plans for pmpcsed work-Draw to scale and note the following if applicable: �T��Y �.� � <br /> •Property Lines 'Outline and dimensions ot all existing and proposed structures on ihe lot •Existing��WlRia�l O <br /> 'Centerline ot street •Indlcata North 5how any proposed greding changes •Show measure�ants �� � <br /> DO NOT WRITE BELOW THIS LINE M 31187 <br /> PERMITCONDITIONS: � 70•pp Z <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-B��In �y O <br /> 2.All work shall be performed in accordance with this permit and current City of Evere l�gsj�and <br /> Construction Standards and Specifications. TO?AL 2780.91 <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-b��EK <br /> 9, �"i ytit�ivte r°o�'�°�° F�no-�� �v s`��e.SP�..-�t�/'. A ORL055 � <br /> -�j• 1� �i n n�5 ke� <FEcx�r L�¢VT,.-�4� ;S bGlow �Q. �� `b► S�¢�, O <br /> itit S{z l � .r.Jr`�cic� �ua�� -�.(1'e SQ.....�.r S e�S.�e.w�. a <br /> ,j <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> `�/J �'y' � / �� The undersigned owner/applicant hereby agrees to hold and save hartnless <br /> � � � S�r,`� lhe City ol Everett Irom any and all claims for damages,costs,expenses,or <br /> Approved lor Construction Date causes of action that may arise because of installation and mai�tenance ot <br /> � ihe improvement or other right•of-way usa hereto applied br and lurther agrees <br /> to remova same upon notice hom ihe Ctty and to replace public properly <br /> <Gt/ /O - y�, -f 7 damaged thereby. <br /> FINAIINSPECTION Date ���„���� <br /> Approved as Constructed ` <br /> / <br /> �- <br /> �n9 re of Applica �' Oate <br /> / <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITNIN 180 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS PR0.IECT OVER 90 DAYS WRATION. <br /> � <br />