Laserfiche WebLink
RH <br />lid <br />H <br />9HCCAA <br />HEX <br />Tit H � <br />O = O <br />V H ril <br />rA H <br />x <br />Rd <br />OH <br />ZOE <br />.(� V ❑r7 <br />z H LTJ <br />HH <br />grA <br />CC3] W rA <br />[r1 171 <br />H O CAA <br />Date-12/17/91 T- 12j-j��- <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />TO POSTING 12-0-92 <br />Public Work, Permit • � <br />4-75 <br />Bldg. Dept a 35085 <br />Public Worka Fee $ <br />Tole, Fee --- <br />LeesApotFee slid <br />Balance Duu <br />Roberr P liege,- Ting tst/ F rr gR9nr '1/,7-7115 -- <br />Owner Mailing Address City Zip Fhonc <br />i EL., <br />_ p SRf'Lr <br />Applicant Mailing Address City ZIP Oc:V.Pl - - P1 <br />1;0^i_E564 <br />Describe Proposed Work _ New 1122sf rambler _ ScWcr 1-1 <br />11 1/ a tt. <br />Project Address (if known) Z I <br />Attach four (4) copies o plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed :.tructures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />LINE <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. in advance - phone 259.9810. <br />f� 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />one. ' Standards and Specifications. <br />3. Call Location Underground Service 48 him before you dig. TOLL FRE1 NUMBER 1-B00-424.5555. <br />1 1 2t- Co•tto113 J1kH V-esEr%4z.'anS 6-� .5hoe.-E Play. <br />r -f•t <br />mc—i&-s2_ lz-zo-si <br />Approved for Construction Date <br />FI L I SPECTIOf ale <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett. WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />z <br />O <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and urt agrees to remove same upon notice from the <br />td to re <br />c property damaged thereby. <br />Signature of Applicant Dare <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />