Laserfiche WebLink
1 ' <br /> � <br /> .._.. <br /> Puoim Wo��a v�.mn• <br /> Date 6/�4/3� I mea o�o� •37129 <br /> qpplicatlon Fo� — <br /> Pu01�G WO�A!F!B <br /> PUBUC WORKS PERMIT ta,a��•e S <br /> Less Ano� Fne Pa�a S <br /> t�l�� oa�r„«o�� S <br /> a H Print or Type Only <br /> ,ozx i <br /> C H <br /> 9 H C/� <br /> H �3 Chuck & Holl Bcltz 405 �iY Z;p Pnonc '� <br /> Kn Owner ldaihng AddreSs � � <br /> y 31 I <br /> "�� H'� Ownei � Zip Phone <br /> ��"� �n�ibn9Address Cily <br /> y ['� ppplicant <br /> Z3 <br /> � Hd <br /> 7�ddition to SFR <br /> pe=cribe Proposed Wark <br /> H �g — ' <br /> n• cG� � <br /> C^ ~'�' � <br /> y H Pwiect Address lil known) 405 Veral r�WaY w <br /> g �y — � <br /> Altach�om(A�copies o�Plans�or proPosed work- Draw io scale and nole�CQo1'erlme of siPeet '` ' N <br /> � �[ri� • propeity Lines • Indicate Norih <br /> y O N • Outline and dimen5ion5 of all e�isbng anA � $how any propo5ed 9ratlin9 chanGes <br /> proposCtl Slrudures 0����e Ioi � Show me.surements M <br /> • Ezisting and p�oPosed utihlies W <br /> DO NOT WRIiE BELOW THIS LW[ O <br /> PERMIT CONDITIONS � <br /> i,All calls lor inspeclion shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be pe�lormed in accordance with this permi�and current C��'y o�Everett ilesign ai�d Construction <br /> '� r. Standards antl Specifications. � <br /> �, ,� 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424'555 • <br /> �- .-�� ��,�G, _ ti%'�. ���_ �:� . . � ��C'�. - ��% � . � <br /> eF ,.,� , l ' i . <br /> . , f�l' % �"� <br /> � , � / •'�/ r � � O <br /> 1 y i Y. <br /> ! dCKNO�VLEDGGh1ENT OF CONDITIONS <br /> Thc untlersi9ned onneVapphcanl herebY agiees Io hold and save harm- <br /> ( ' ' iess the Gty ot Everetl from any and all claims lor tl.mages, cosls. <br /> �. � expenses. or causes o� ec�io� thal may arise because ot inslallNion <br /> and maintenance of �he improvement or othe� ��9hLol-�vaY U5e here�o <br /> applied lor and �uriher agrees lo iemove same iiPen nolio� trom tne <br /> � '" Fppmved for Consimction <br /> Date Cdy���d to replace public proPerty damaged the�eUy. <br /> Da�e ���'�O <br /> FINAL WSPECTION Si9na�me ol APPlicant <br /> �nnrovedasConstmcied N'OAK AUTHORIZED BY THIS PERMIT h1U5T BE START[D \VITHIN <br /> ;._-7 PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUEO AND 7HEREAFTEH IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERAtIT MAY 8E <br /> � Everee,WA 98201 CANCELLEO BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonr�.759�8010 PROJ[CT OVER 50 DAYS OURAtION. <br />