Laserfiche WebLink
Date <br /> � � Puopp Worka Permp� -� <br /> Applicatlon For eldp.DeO�.t <br /> PUBLIC WORKS PERMIT PuGlicWorksFee <br /> Totsl Fee S <br /> Leu AOCL Fee Psitl S <br /> Print or Type Only Plpan Check No: C 43842 SEPA Balan�e Due S��__ <br /> APJobcAddreeee 21191MApLE ST <br /> Owner: CECIL RON <br /> Tenant: <br /> Propoaed Uee: SINGLE FAMILY RESIDENCE <br /> Owner Deec. of Work: <br /> ADDITION OF TWO BEDROpHS & HATH Z�P Phone � <br /> Applicant OFFICE SET JOB SET <br /> APPROVED FOR PERMIT: DATE Z�P Phone <br /> ��_/__ BY <br /> Describe Proposed Work <br /> Project Address(if known) � <br /> Attach four(4) copies of plans(or proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centeriine ol street — <br /> • Outline and dimensions ol all existing and /w <br /> proposed structures on the�ot � ��dicate North �� <br /> � Existing and proposed utilities • Show any proposed grading changes <br /> • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls for Inspection shall be mede 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction � <br /> Standards and Specifications. <br /> 3.Cali Locatton Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800•QQq-5555. <br /> � <br /> PUBLIC WppKS PERMI7 O <br /> NOT EpU1RED H <br /> BY � <br /> DATE 3 2 � � � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS - <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol Everett Irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance ot the improvement or other right-ol-way use hereto <br /> Approved for Construction Date applied for and further agrees to remove same upon notice from the <br /> Cily and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved ae Constructed Signature ol Applicant <br /> Date <br /> PUBLIC WORKS DEPARTMENT N10RK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILfGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259•BB70 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER�0 DAYS DUFATION. <br />