Laserfiche WebLink
Date 9�2z�83 Pu�l¢\`/aksPermR• 4y '�'7 <br /> emu.oeo�.• 83/12 S� <br /> Application For <br /> PUBLIC WORICS RERMIT P°°'�°"'°"1FBe � <br /> TolalFee S <br /> Lass AD��Fee PaiE S /� <br /> BdId11CB�IIfl � <br /> Print or Type Only �. ;T �����-. <br /> ���� <br /> Projects West Lts. 10209 Bridge Port Wap S.W. Tacoma 98499 582-6840 <br /> Owner Ma•ling Address City Zip Phone <br /> Same _ <br /> Applicant Mail�ng Address Ciry Zip Phone <br /> New Single Family Residence <br /> Dr.scribe Proposed Work <br /> --- W <br /> Projoct Address(it known) _ � � �^ M G �� �/ �o f� S � <br /> AUach lour(4) copies of plans for proposed work- Draw lo scale and note the tollowing as applicable. � <br /> • Property Lines • Centedine ol street � <br /> • Outline and dimensions of all ezisting and • Indicate North <br /> proposed structures on thr, lot • Show any proposed grading changes <br /> • Existing and proposad u;ilities • Show measurements !,� M <br /> DO NOT WRITE BELOW THIS LINE � W <br /> PERMIT CONDITIONS � <br /> t. All calls tor inspection shall be made 24 hrs. in advance- uhone 259•881 5. � <br /> 2, All work Shall he perbrmed in accordance with this permi�and currr.nl City of Everelt Design and Cer�svuctio�� � <br /> Standerds and Specilications. � <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•£300•424•�aS55. � � <br /> r. <br /> r: <br /> �f, ST.ec�.— /��.�E_'o�/�le=--J7�' <�%G �fi'�`'�'�fl/�� O <br /> p<_� r7�i�� �_- �-��f� <br /> ~ � � <br /> � H -. <br /> � �; <br /> O � � <br /> a � ` <br /> � � <br /> � � <br /> � <br /> �y :. <br /> ACKNOW�EDuEMENT OF CONUITIONS H F- <br /> The undersign�d owner/applicant hereby agrees to hdd and save harm� � �' <br /> ---- less the City of Everolt Irom any and all claims tor damages, costs, n s;. <br /> expenses r causes of ac�ion Ihat may arise because ot installation �-r� r; <br /> �_� /� ���U- and ma nt nance ol the improvemant or other right-ol-way use hereto F-,; <br /> � appl� d[Y r and furiher agrees �o remove same upon notice irom the � <br /> Appr v for Const'_\tion Date Ci ;arttl to repl�lic rop ity aqe �1 ��� <br /> , �L{-s:� � , / > � �� � � r. <br /> ', 9- // � <br /> FINAL INSPECTiON � Dale � �'"�`"� �" ��� � <br /> Approved as Construcled ` � � Si •aWre of Appli t ate � �C <br /> everett PUBL�C WORKS DEPARTMENT ORK AUTHORI2ED BY THI PERMIT MUST BE STANTF.D WITHIN `� <br /> 180 DAYS OF DATE P[RMIT IS ISSUED AND Tf1EREAFTF_R IS TO r <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS h`ERMIT MAY BE <br /> Everett,WA 98207 CANCELLED BV THE CITY UPON FNY S?OPPAGE OF N'ORK ON THIS <br /> Phone: 259�8875 PROJECT OVER 90 DAYS DURATION. <br /> i; <br /> i <br />