Laserfiche WebLink
o�— <br /> i <br /> App'ication For � <br /> o- " �� � <br /> PU13LI� WAf�KS PEfiMIT Da�e_z-/¢-9 � <br /> PUBLIC WCRKS DEPARTMENT Public Works Permit# �7/7 ZS <br /> 3200 Cedar Street ! <br /> Everett,WA 98201 259-8870 Building Permit It__ _ , <br /> TYPE OR PRINT ONLY Pu61ic Works Fee S 5/.?S <br /> �Avp ,Jr�cd �� 1�o1 ' �ysTSE EiereTl- <br /> Owner Mailing Address City Zip Phone <br /> f�ic� atc� LA��a✓J�IIE' _G7ofl -/S� Tfil�vF_SES�pliemJsll .��Fr.2.20� <br /> Applicant ailing Address City Zip Phone <br />, Describe Proposed Work�i // L� L T ��7� <br /> W <br /> ,g�, �������; .� � <br /> � <br />� � <br />� PROJECT ADDRESS(if known) .��G'�"�'j�y $ T .S /e � <br /> Attach four 4 co ies of lans for ro osed work �Draw to scale and note the followin if a licable: 07 �2-9� 10:�6A�1 <br /> O P P P P 9� PP � �7"B � <br /> •Property Lines •Outline and dimensions of all existing and proposed structures on ihe lot •Existin��roposed W'�tie� <br /> •Centerline of sireet •Indicate NoAh •Show any proposed grading changes •Show measure�l�� �9.n� <br /> DO NOT WRITE BELOW THIS LINE 5""' <br /> PERMIT COI�DITIOW�: A OF10i7 � <br /> 1. All calls for inspP�tion shall be made 24 hours in advance- phone 259-8810. � <br /> 2. All work sha!I be perforined �n accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> �� � .S�C Lury� Cl^RSS CiS SOOi� 2S �LL /S J�QG�O , � <br /> ✓ / <br /> , J`,� /"i'+Dvt��E Ct.7y �'1CCCI�.'4.�i, �/ ��-OS�Or� �'O/� 9�i�0 L 2S o <br /> �i��c_�,e� 6Y ��hc f�6C.`� Wor.�s• I�s�zc��.-� , 0. <br /> �v, �u=� G�¢y Sfr��7�1 Cl�4s� ¢7� aL� 7�ih�as • <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> / The u�dersigned ownedapplicant hereby agrees to hold and save harmless <br /> . 'O��,� !8 9 �he City of Everett trom any and all claims for damages,costs,expenses,or <br /> � «C` causes of action lhat may arise b�cause of irstallation and maintenance of <br /> Approvedf nstrudion ate �heimprovementorotherright-of-wayuseheretoappliedfora�dfurtheragrees <br /> to remove same upon notice from the City and to �eplace public property <br /> d/��. �G_ 7 .5:] damaged thereby. <br /> FINAL INSPECTIQN Date <br /> Approved as Constructed �1 <br /> t/ /w,� A ! la�'17 <br /> ,nature of Applicant Date <br /> WORK AUTHORIZED BY THIS PER�AIT PAUST BE STAR'EU WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELEl7 GY TNE G:N UPON ANY Sl'OPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br /> r- <br />