Laserfiche WebLink
Date <br />ppplication For <br />PUBLIC WORKS PERMIT <br />Print cr Type Only <br />Owner <br />Applicant <br />Descrlbe ProDased Work <br />Project Address (if knrnm) <br />Plan Check No: <br />Applicat.Date: <br />Job Addre: <br />Owner: <br />Tenant: <br />Propoaed Use: <br />Desc. of Work: <br />ADDITION <br />C 41632 SEPA <br />OB/10 93 <br />424� S RD ST <br />WILDMAN JOANNE <br />SINGLE FAMILY RESIDENCE <br />OFFICE SET JOB SET_ <br />APPRVD FOR PERMIT: DATE_/_/_ <br />Poeuc WOA� ParmX r <br />8100 Dao�. � - <br />vueiKwon��f•o i <br />Toltl Fe� <br />L�u �ppl FM PtiC f <br />B�4�K�Out / <br />Zip Phone <br />Zip Phone <br />Attach four (4) copies of P�ana for proposed work • Draw to scale and note the following as appliwble: <br />• Pr�perty Llnea <br />• Outline end Oimensions ol all existing and <br />proposed structurea on the lot <br />� Eziating and Droponed ulllities <br />• Centerline o1 street <br />• Indicate North <br />• Show any proposed grading chenges <br />• Show measurements <br />PERMIT CONDITIONS <br />t. All ulls for inepection ehafl be mede 2a hra. in advance • phune 259-8810. <br />2. All work ahefl be pertortned in accordence with thia permit and curtent City of Everett Design and Constructlon <br />StendaMe end SpecNlcatlons. <br />3. Cell Location Underqround Serv�ce 48 hre. before you dig. TOLL FREE NUMBER 1•800�424•5555. <br />fo� Constructi�n <br />PUB No?W EQUIRED MIT <br />BY `� / / � j <br />OAT! <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />S�PUBLIC WORKS DEPARTMENT <br />3200 Ceder Sireet <br />EveretC WA 98201 <br />Phone: 259-8810 <br />ACKNOWIEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />The undersigned owner/applicanf hereby aBrees to hold and aave herm• <br />less the City ol Everett irom any and all claime for demeges, costs, <br />ezpenses, or causes of action that may arise because of instaltatlon <br />and maintenance of Ihe improvement er olher right-of-way use hereto <br />applied for and further agrees ro remove same upon notice irom the <br />City and to replace pub�ic property damaged lhereby. <br />Signature ol Applicanl Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br />8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEF 90 DAYS DUHATION. <br />