Laserfiche WebLink
Date �_��i_� I <br />Ap0licatlon For <br />PI�BLIC WJRKS PERMIT <br />Print or Type Only <br />f'� ila�'.�/ �g <br />Owner Ma Iling <br />CiIY Zlp <br />Puoi¢ WOM Para�� • / � �� / <br />. <br />BWp Dap� • <br />wmK won� �« � - ' <br />Tobl M1s { <br />I.en �ppl fu P�iU i <br />B�i�nu Oua { ��. <br />sA,�s .y •;_��o�� <br />ApD��r.ent Maillag qddress Clly Zip Phone <br />Deecrlbe Propaeed Work <br />P�o�ect Addreee (11 known) _ S2� .�0� � �..t E <br />Atlech lour (4) coplee ol plane for propoeetl work • Drew lo ecele and note Iha lollowing an eppllcable� <br />• Proparty Linee <br />• U�tline end dlmenelons ol ell e�iellnp and <br />propoead etn�cturne on the lot <br />• Falslinp and propoaed uflllliae <br />Approved lor <br />PERMIT CONDITIONS <br />� Ga�ilarllne of atreet <br />• Indicele North <br />• Show any propoeed gredlnp chenpee <br />• Show measuramanle <br />1. All cni '��nepectlon ehell ba meda 24 hra In advance - phone 259•881 8 <br />2. All won �,�,dl be pedormed In accord�ncx with ihfe permlt entl current Clly ol Everell Deelgn and Conetruclion <br />3landards and 9peci1lcatione. <br />3. Cell Lxetlon Underpround 3ervice b8 hre. before you dip. TOLi FP,EE NUMBER 1-800•424•5b55. <br />f� �//'L�C,t�ir/"i /yJvsT f�'O[/i��' 7rJ/E �'jT� <br />u/�r,y .f' �,�y a�" �v u� ro-�r�J �'�o.�vF� <br />SEnr�r �ir, %�,Pin�T i".�oiri TiYE S'.u��4'anvsri� <br />f�E"9cTi!' dis�.e�cr BE'�,��' 8y�i o�,vG f�.��,-��T <br />It'/ilC BE .�.�uE.O , . <br />FINAL INSpcC'r10N ' �� %� � <br />Approved au COnetrur.ted v <br />everett PU�LIC WORKS DE?ARTMENT <br />� 320C Ceder Street <br />Evorelt. WA 88201 <br />Chone:259�8815 <br />ACKNOWLEDGEMENT Of CUNDITIONS <br />0 <br />W <br />� <br />� <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />The unde�signed owner/epplicenl hereby e�reee to hold end eave he�m- <br />lesa the City ol Evaretl Iran eny end ell claime lo� demapea, costs, <br />eKpenses, or causes of achon thet mey erine bece�ea ol Inetellalion <br />flnd malntenenca ol Ihf improvement or othar righl�ol�wey uae hareto <br />nppliad �or end lurther epreas to ramove eame unon notite Irom Ihe <br />City end �o replece pi.bHC proparry damapeC thereoy. <br />� % � �y/ `. _ � ' i <br />' LJ <br />s�pnatur ol AUV am (i ✓ nat <br />WORK AUTHObIZEO BV THIS PERMII� MUS� BE STAHTED WITH�N <br />1B0 UAYS OF DATE PERMIT IS ISSUED AIJD THEREAFTER IS TO <br />BE DILIQENTLV PURSUED TO COMPLETION. THIS PERMiT MAY BE <br />CANCELLED BV THE CITV UPON ANV STOPPAOE OF WORK ON THIS <br />PROJECT OVER 90 OAYS DUNATION. <br />