Laserfiche WebLink
i <br /> P�.it'i.::Wo�ks Pcrm��a '� �� �� ���� - <br /> Date��1/19jd4 � , <br /> �'..1g Daot� � <br /> � AppliCation Por I <br /> PUBLIC WORKS PERMIT FubhcWorksFee s <br /> Tata�Fer <br /> ILesa AoO�Fue Pa�C $ -- i <br /> Balance oua S ��`� ��'� <br /> Print or Type Only <br /> Gilbertson 1512 45th Street Everett 98201 259-3580 <br /> Owner <br /> MailingPddress Gity Zip Phone <br /> Solie Builders 7514 Juniper Drive Everett 98203 353-2331 <br /> Applicant <br /> Mailing Address C't•/ ` �11On`� <br /> Driveway and qarage _ <br /> Describe Proposed Work --— ---—— �� <br /> � <br /> Prolect Address(if Icnown) _ <br /> 1512 45th StreeY. _ h <br /> � <br /> Attach !our(4) copies of plans lor proposed work- Draw to scale and note lhe folbwing as applicable: � <br /> � Property Lines • Cenierline of street <br /> o Outline and dimensions of all existing and • Indicate North <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> G Existing and proposed utilities • Show measurements /� <br /> W <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1. All calls tor inspection shall be made 24 hrs. in advance- phone 259•88�5. <br /> 2. All work shall be pertormed in accordance with this permit and current Ci1y ol Everett Design and Construction <br /> Standards and Specilications. � C <br /> 3. Call Location Underground Service 48 hrs. belore you dig.'fOLL FREE NUMBER 1-800-424-5555. <br /> � <br /> y, E-X,s,-�,vG d,�ivF.d.ay .a.c v fu�Sd.6' £ ��,-�e,z sE'c;;e.✓ O r; <br /> ^'IG'ST f�E �'Fa��a'ED Ati':J .PEPCACE.� w��t/ F�•� �- <br /> , �U/zd � C-UTrE.P �'V� SiG�:WAt,c , � <br /> y�'rc yr , <br /> NEtv D���'EwAy/ /S To dE Bv�cT PE,e S�C%�o'� ♦/� .� <br /> f Co.tls7.ev<Tio�t/ d�� ^ ' <br /> 3 3 7 oF T�r� c:ry vf" EdE.�'�'Tl �r�6�c.�✓ � : <br /> 0 <br /> .:i<�iL'UA,�.�S, ��'�' .�i7�cflc:n�� � <br /> � � <br /> a � <br /> 6 : <br /> r- : <br /> 4CnNOlVLEDGEt�fENT OF CONDITIONS - <br /> J ' <br /> Thc untlersigned owner/appticant hereby agrees to hold and save harm- a ; <br /> --- irss the Gity of Everett trom any and 211 claims for damages, costs. <br /> . c.penses. or causes of action that may arise because of installation O �' : <br /> , / v ! /��/jb,� and maintenance ol the improvement or other righFof-way use herelo <br /> ��y ./�n-c•fL � applied tor an further agrees to remove same upon notice trom the � ; <br /> Approved for Construction / Oate Gty a to {lace Puplic proper damaged t6ereby. / � <br /> / i i � <br /> "� / " /=2/=�r — � . � . ?t <br /> F1NAL INSPECTION Date � � � . <br /> Approved as Conslructed Signature ol �cam <br /> WORK AUT ORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> eaemtt PUBLIC WORKS DEPARTMENT 180 DAYS UF DATE PERMIT IS ISSUED AND THEREAFTER IS TO , <br /> � 3200 Cedar Street BE DILIGENTLV PURSUED TJ GOMPLETION. THIS PERMIT IdAY BE <br /> Everett.WA 98201 CANCELLED BY THE CI7Y UPON AtJY STOPFAGE OF WORK ON THIS <br /> Phnnc 259�8815 PROJFCT OVER 90 DAYS DURi,TION. <br />