Laserfiche WebLink
1 <br /> T n T 'r ^ G—, -3o—Z8-5 � <br /> Date <br /> 3-19-9'L i� 1"n�1���G __1__'l�Y�� r�ei��wo,here,ma. `"�'Z � �3S _ <br /> oina oeo� •���8 -- <br /> Application For <br /> yOH – <br /> ��y PUBL�C WORKS PERMiT °°°raw���"° 5 <br /> ��� U�55 PpDI Gre PaN $ <br /> 9 H V� o,���«o�0 5 �V_— <br /> t+ Print or Type Only <br /> K �O 'Larlingo <br /> O S O Benjamin SR%IH�{t4 8823 Holly Dr. 11A206 Everett 98208 335-2410 (work) � <br /> � ~� Owncr Maiting Address City Zip Pnone <br /> VJ H <br /> y r <br /> z� <br /> � y d Owner <br /> � <br /> O H ApPlicant Mailing Address Cily Zip Phone . <br /> H �8 ; <br /> �` n new SFR � <br /> zH Describe Proposed Work : <br /> ay� <br /> r z <br /> h+H <br /> `� W f <br /> H <br /> C� C� <br /> [� �h Proiecl Address 1�1 knewn� 14915 Silver Lake Drive � � <br /> Z H q, <br /> H O V� Attach lour(4)cOpies ol plans for proposed work� �raw IC scale and note the lollowing as apP�icable: � � <br /> • Properry Lines • Cenleriine o�street ♦^ � <br /> • Outline and dimensions of all existing and • Indicate Nonh V� <br /> proposed strucNres on t�e lol • Show any proposed pradin9 channrs <br /> • Existing anA proposed utili�ies • Show measmements � . <br /> �� DO NOT WRITE BELOW�1 INE ' <br /> �^ PERMITCONDITIONS O <br /> .� .,� i.All calls lor inspection snall be madr.2a n, ia advance-nhone 259•881 Q ^ ; <br /> �� 2.All work shall Ue pedormed in accoi:= ue wl+n �.i;.s permit anA cmrer�City ol Everett Design and Consimction ♦ . <br /> Standards and Specilicatio�s. �� <br /> 3.Call Location Underground Service 48 hrs.br.lore you tlig.TOLL FREE NUMBER 1•800•424•5555. � , <br /> �y. 1 <br /> � � O <br /> E.,. �` � <br /> .... „� 'A <br /> V♦ I <br /> (Q��) O <br /> !� j � I <br /> � <br /> !� ti.' ACKNOWLEDG[MENi OF CONDITIONS i <br /> � � i <br /> The untlersiqi�eU owner/applicant hereby agrees to ho .n s:+ve �amr <br /> —� — less the City of Everelt Irom any and all daims lor damages. r.osls. i <br /> ))) enpenses, or causes ol aclion Iha� may aiise because ol mslalla�lon <br /> �C� � // � 4 7 9 ;�nd maintenancr. of Ihe improvemenl or olher ri9hPof-way use hereto �. <br /> /.f ' ��� � " _2��' " Z applicd lor and Imther a9rees to remo:e same upon notice imm ihc <br /> Appwve pr Construction ���� City and to r�e UuUlic P�operty dama9ed Ihereby. I <br /> � � N <br /> F 1� C I � � Date � �� <br /> Approved as Construcled Sig�re ai ApP� Uate II <br /> � AUBLICWORKSD[PAR7MENT WORK AUTHOHIZED �Y Th115 P[RMIT MUST BE STARTLD WITHIN <br /> � 180 DAYS OF DATE P[FMIT IS ISSUE'1 AND THEREAFTER IS TO i <br /> 3200CedarStrcel BE DILIG=NTLV PURSUED TO COMPLHTION.Th15 PERMIT MAV BE <br /> Evcrett,WA 98201 CANC[LILD 8Y THE GTY UPON ANV STOPPAGE OF WORK ON TIIIS <br /> Phone:25&8810 pROJECT OVER 90 DAVS DUfiATION. <br />