Laserfiche WebLink
� �r�i <br />�yHV� <br />H �� <br />� H� <br />'� N'+J <br />V1 H <br />Zp <br />�HC <br />H/��g <br />y� Y � <br />�yH� <br />t" 7C <br />V�i y <br />g�� <br />[v <br />HO� <br />Date <br />10-31-91 �'.Zb - 2.'-� ;•'-. <br />Applicution For <br />PUBLIC WORKS PERMIT <br />Print or Type Only jQ POSTING �D a L <br />GREG BECKMAN <br />OWNER <br />Applicanl <br />Descdbe Proposed Work <br />Proiect Adtlress lil known) <br />P�� BOX 2184 <br />>Aailing AddreSs <br />Mailing Address <br />NEW SFR <br />2 4�5z, I-�; �h 1 <br />98036 <br />City Zip <br />Punhc Worl.s rmmn • ✓ 1 � . � <br />eiee.oeo�.. YYYHtYX O1 /97�j_ <br />PULhc Waiksfoa S <br />TomlFar <br />less RpPL iee Px�� g <br />oam��a o�� S 7 � <br />I'hone <br />�,�:�?;:"� l��iy`•'�_-_� <br />-.• SiGiTEF �550.C7C <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the lollowing as appiicable: �Ou��E5�7 <br />• Property Lines • Cenledine ol streel �, �-, <br />3�vl�rt � ;p,pD <br />• Outline and dimensions of all existing and • Indicale North . �� ,v�, - <br />pmposetl strucWres on the lot • Show any proposed gradin�lch��es �- ••�•�'" <br />• Existing and proposed utilities • Show measurements NOi.�. i07'. <br />_ _ e: nr, <�' ^ �','1 <br />DO NOT WRITE BELOW THIS LINE ;'LE'G +45.��D <br />� "�C� 3>ii.�?U <br />PERMITCONDITIONS �; �� ,`h �^,:r� <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259-88� 0. -� <br />2. All work shall be pedormed in accordance with ihis permit and current City ol Everett Design�aoBCDonstrucU0n;i0 <br />StandartlsandSpecificationa �UU" u^0,��_'. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800• ZfH�55�.�-, � �,:• <br />'f, �e p 1ace, b,ro Ke� s 1 d e wa � k o•� z.5 t�, St F��ta9 e <br />, <br />.(-�-o� a�1ey -�� aP�O�M1� �a�AO� �O E/oF aUe�. <br />O" <br />�, Q �'l�` �CQ.s�, I (-1z-91 ' <br />Approvetl lor Construclion Date <br />, <br />�� �.�,�� ,� -r � � �- <br />FINAL INSPECTION Date <br />Approved as Constructed <br />/�r�PUBLIC WORNS DEPARTMENT <br />32C0 Ceder Streel <br />Everetl, WA 38201 <br />Phoito: 259 8810 <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />N <br />O! <br />ai <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi9ned owner/applicant hereby ac�rees to hold and sav^ h��m� <br />less the Ciry ol Everett Irom any and all claims lor damages, cos s. <br />expenses, or causes ol action Ihat mny arise because ol installr�tion <br />and maintenance ol the improvemenl or other right�ol-way use heretu <br />applied br and Iurlher ac�rees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />�--�, �t-�-q� <br />Si9 �tu I Apnlic nt Date <br />WORK AUTHORIZ D DY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE P[RMIT IS ISSUED AND THEf7EAFTER 19 TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE GTY UPON ANY STOPPFGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />