Laserfiche WebLink
Date <br /> PUCIi<Work�P�rmil I -- <br /> Application Fo� eieo-oso��• <br /> PUBLIC WORKS PERMIT P����cWorkaFa� <br /> im�l Fu S��� <br /> leu�ouL Fee P�iE s�� <br /> Print or Type Only e.�.��eo�a s�_ <br /> . Plan Check Nos C 44252 <br /> Applicat.Date: pq/yg/gq SEPA <br /> Owner Job Addrea�t 1521 hUCKER AVE <br /> Ownez: TREDWAY THOHAS M Phone <br /> Tenants <br /> � Proposed U�ai SINCLB FAMILY RESIDENCE <br /> Deec. of Work: <br /> Applicant ROpHpDENEWXFOUNDATIONRAND PROCy STEppLRCE <br /> Phone <br /> Describe Proposed Work OFFICE SET��JOB SET <br /> APpROVED FOR PERMIT: DATE_/_ <br /> Projett Addres5�if knOwn) � <br /> Attach four(4)copies of plans for proposed work•Drew to scale and note the lollowing as applicable: � <br /> • Properly Llnes • Center�ine of street <br /> • Outline and dimensions ol all existing and • Indicate North � <br /> proposeA slrucfures on the lot • Show any propcsed grading;�hanges <br /> � Existinp and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDIT�GNS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. <br /> 2.All work shall be peAormed in eccordance with this permit and current City of Everett Design and Construction ' <br /> Slendards and Specificatlons. <br /> 3.Call Location Underg�ound Servi�e 4B hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. <br /> � <br /> O <br /> . � <br /> k Bf�I�M�� � <br /> �d���T���U�E� O <br /> a <br /> gY <br /> O�ZE � , <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Eve�elt Irom any and all claims for damages, costs, <br /> ezpenses, or causes ol action that may arise because of inslallation <br /> and maintenance ol lhe improvement or olher right-of•way uae hereto <br /> Approved lor Construction pa�e applied for and furiher agrees to remove same upon notice 6om Ihe <br /> City and to replace public property damaged thereby. <br /> FINAL INSPECTION Dale <br /> Approvetl as Constructed Signature ol Applicant <br /> Dale <br /> PUBLIC WORKS DEPARTMENT WORK AUTliOR12ED B1' THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERM�T IS ISSUED AND THEREAFTEF IS TO <br /> Everet4 WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259•BBtO CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJFCT OVER 90 DAYS DURATION. <br />