Laserfiche WebLink
, <br />Dates��'� � <br />Appllcation For <br />PUBLIC WORE:S <br />Print ur Type Only <br />PERMIT ��- " <br />��� �� �;C�� <br />a�or��wmxsPa,mn. ,'�' S- /G'/ <br />85/14438 <br />ema oeri. • <br />PuElic Wo�ke Fee s <br />,o�a� F<a � <br />�osa noo� Fee aam S <br />saia��e o�a S �.'3ti?. � -�,' <br />�Sno! iish County Physicians Corp. 7600 Evergreen Way Everett 98204 <br />— Mailing Address City ZIp Phone <br />Ki. .� 'Cole Assoc. P.O. L-•ox 605 <br />Mailing <br />RYAffC Snohomish <br />City <br />98290 56II-21;S <br />Zip �hone <br />�Descrihe ProPosed Work �E/nlJI�F'i /�'i ri�i.l�'l- /�3ddc I����i-di+ GiJT <br />/�EHiI✓D .4i�G C.JA/-iT,C'UCi �//cI�ET �I�l��/�-D{�� ��IF=^�'� <br />-36BB�Evergreen Way <br />Prolecl Address (if known) <br />Attach four (4) copies ol plans tor proposed work • Draw to scale and nole lhe tollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all exisling and • Indicate North <br />proposed strucWres on the lot • Show any proposed grading r.hanges <br />• Existing and proposed utilities • Show measuremenis <br />PERM�T CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be per(ormed in accordance with ihis permit and current Cily of Everett Design and Con,truction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�'�, TECEP//o�E /�OcE" �" GiG%iT ��oLES Tc� �3E f'crGnC�JTCO <br />TO Bf=�Y�N� S�DE's✓,eG.0 AT AP%�GiGd2�TS �'Xf�En,�CE. <br />J /�POL�Gd�t/% Si�,o�1 C'D�LST.�UCT LAtiUSCa/�� A.t>E4 S <br />ANP S�j'EL-��✓�iriG- Or�J iTE /�'Ei_' SEPA '� ?O -$� <br />.f'G�Ui.�Ei,a�nrS� APi'LiIaNT -s�f.a[C f'�'a�%-UF /�L.ai✓S ��3 <br />fJP/�s'?oYt�L TO %L/F L�i7y � r:S!' ��G�iN.^tlr�t.�� .f?�PGiTirlF/��%, <br />L.�, tSf.E'EEET 1/.?/'i,.t ��,E /.7Eri1T.S %O <br />IG /l I�i:iGi:'G'L% �/_Q/.lS �%l /•�� Q <br />ACI:NOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less ihe City of Everett irom any and all claims lor damages, costs, <br />expenses, or causes ol action thal may arise because of installation <br />and maintenance of the improvement or other righ4o4way use hereto <br />- applied lor and lurther agrees to remove same upon notice from the <br />City and to replace public property damaged lhareby. <br />Approvedfor <br />�>�- �c,;✓,c�r2 ���rcv <br />4" L)QTl-�L� '� /:4�-c7'S� <br />FINAL INSPECTION \ <br />Appmved as Constructed <br />everett PUBLIC WORKS <br />� 3200CedarStreet <br />Everelf. WA 98201 <br />Phone:259-8815 <br />1 <br />Date <br />W <br />F- <br />N <br />�1 <br />� <br />O <br />� <br />� <br />� <br />a <br />— ��GY�/��� •-/��,�_��--. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITH�N <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />