Laserfiche WebLink
oe'e s-11-93 TO POSTING ��� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PuDhc No�M Perm�t • � L� / / <br />awo o�o+ • 40 <br />Pu�i¢ works Fee s <br />Totel Fee <br />Leas Roo�- Fee PsiC s <br />Balance Due S ��O—� <br />GOZ-3.��S�G //,�'3/ <br />Jeffrey Guetafson 5416 Wetmore Ave Everett 98203 355-0204 <br />Owner Mafling Atldress City Zip Phone <br />Ow+ner <br />Applicant Mailing Address Ci�y Zip Phone <br />Describe Proposed Work <br />Project Address (if known) <br />Attach lour (4) copies of plens for proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Linec <br />• Outline and dimensions of all existing antl <br />prnposed structures on the lot <br />• Ezisting and proposed utilities <br />• Centerline of slreet <br />• Intlicate North <br />• Show any proposed grading changes <br />• Show measuremenis <br />PcqM1T CONDITIONS <br />1. Ai; calla for inapeclbn ahell be made 24 hra. in edvance • phone 259-881'). <br />2. All work shall be pertormed in accordance with this permit and curcent City of Everett Design and Conatrudion <br />Stenderda antl Specifications. <br />3. Cell Locatlon Underpround Service 4A hrs. before you dig. TOLL FREE NUMBER 1•800�4245555. <br />7, �/p �CC �s f�= �(cz«o� �n f/�e �clG_>y /�i,/f-o{-Ct/ay <br />//ii.t /�iaj/ /L-�vi.•c t/�e no.-f/-[�rf Co�.ficr o�''f! <br />/� / J ,� �9�.r.y�s <br />ipt/nVlifiOi� 6e" ('Di75f�UC�dU �4�L�'r f/1G/7 Rhf/C/�a.TC�, <br />�1�� .s�9/ �' <br />Approved for ConstfuC�ion�� ate <br />� <br />�/�� S-/ 7' �� � <br />FINAL INSPECTION Date <br />Approved as Constructed � <br />�PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259•BB10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />The undersigned owneUapplicant hereby agreea to hold and save harm� <br />less the City ot Everetl irom any and all claims tor damages, costs, <br />eapenses, or causes o1 action that may arise because of installalion <br />and maintenance of the improvement or other right-of-way use hereto <br />applietl for and further aqrees to remove same upon not�ce from the <br />City and to replace pub�ic propert�,dama�Q thereby. <br />S n ot licant DaYe <br />P <br />AU ORIZE BY HIS P MIT MUST BE STAFTED WITHIN <br />1 DAVS OF DATE RMIT I ISSUED AND THEREAFTER IS TO <br />E DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />GANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEii 90 DAYS DURATION. <br />