Laserfiche WebLink
LW0fk-P-Fffl P.nn 1. •�Dale_-- .Application For Fee ,PUBLIC WORKS PERMIT P.Id S-� <br /> Print or Type Only 711,23 <br /> Nancy Lervick 1427 South 11th Street <br /> Mt. Vernon 98273 336-2979 <br /> Owner Melling Address <br /> City Zip Phone <br /> Same <br /> City Zip <br /> Applicant Malling Address <br /> Phone <br /> Construct Duplex <br /> Describe Proposed Work <br /> — W <br /> Pru)ect Address(II known) <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note t Oeolowing of as applicable. <br /> 0 Property Lines • indicate North <br /> • Outline and dimensions of all existing and a Show any proposed grading changes <br /> proposed structures on the lot a Show measurements LU <br /> • Existing and proposed utilities <br /> DO NOt WHITE BELOW THIS LINE <br /> PERMIT CONDITIONS <br /> d <br /> 1, All Calls for inspection shall be made 24 hrs in advance• phone 259-8815 v <br /> Construction <br /> 2. All work shall be performed In accordance with this permit and,current City of Everett Design and <br /> Standards and Speciflcalicna <br /> 3 Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. fF <br /> rS <br /> tri <br /> �-Gnrc•� STEEL— GwJrED GCC' Cce/tc'bQ�EAI � F+ . <br /> h10 ct- �Q L t.13Fr-cry 6*) O-LV ^ l Raj <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm C`I <br /> less the City of Everett from any and all claims for damages, costs. <br /> expenses, or causes of action that may ansa because Of installation 7� <br /> — / y <br /> and maintenance of the Improvement or other righl•otway use hereto <br /> applied for and further agrees to remove same upon notice from the El <br /> Dele Cly and to Molace public pr6perly dam <br /> Approved for Construction <br /> aged thereby. FI <br /> U1 <br /> Data Dote <br /> FINAL INSPECTION ignature of Applicant ARTED WITHIN <br /> Approved as Constructed WORK AUTHORIZED 8Y THIS PE IT MUST BE <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS T <br /> 3200 Ceder Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY IS n <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS . <br /> Phone: 2590815 PROJECT OVER 90 DAYS DURATION 1 <br /> r <br /> r <br />