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TO POSTINBPR 1 a 2000 <br />Application For <br />PIiB�IC WORKS PERMIT <br />TYPE OR PRINT ONLY <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, W.', 98201 (425) 257-8810 <br />�, <br />Date _ 4-29-99 � <br />Public Works Permit A �� <br />Building Permit H 62306 <br />Public Works Fee S w _ <br />Key Nomes 5223 128th P1 NE Maryeville 98271 425-239-2684 <br />Ownor Mailing Adtlress Ciry Zip Phone <br />Owner <br />Appliwnl Mailing Address Ciry Zip Phone r� <br />Describe Proposed \Nork new house — Basic 2041 _ <br />PROJECT ADDRESS (if known) <br />Blvd <br />98 <br />Attach four (4) copies plans lor propnsed work - D�aw to scalo and note Iho lollowing il , pplicablo: <br />• Proparty Linos • Outtine a�d dimansions of all existing und yroposod slructuros on Ihe lot • Existing and p�oposed ulilities <br />• Centerline of street • InCicato Nonh • Show any proposod grading changos • Sl�ow measuroments <br />DO N�T WRITE BELOW 1rtIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be rnade 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be per(ormed ir. accordance with lhis permil and current City ot Everett Design and <br />Construction Standards and 5: ecifications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMDFR 1-800-424-5555. <br />�, 7� SchZ,rz�G c�wnSPovt. s-�u spl�s�, blocks , <br />�j, Th.c C�eo{c��+ rc�crt- �,!• Kei� Grvss dc�tcd 5/4"/q8 <br />,� � accs . v� � 1 I-�c,r�d ��z <br />�y ACKNOWLEDGEMENT OF CONDITIONS <br />� � � The undersigned ownerlepplicant horoby agraes to hold and savo harmless <br />the City ol Everon Irom eny and all claims for damages, costs, oxpens=s or <br />� pp o or ns ruc ion � e ceuses ol uction that may adse because of InstallaUon and maintenanco ol the <br />impmvemenl ar other right-of•way use horeto applied lor and lurther agrees to <br />i/� //��� p remove same upon notiee from tho City and to repia�e public property dam- <br />��,/��e/� (� f �� •�' / �/ agedthe�epy/� .r <br />/r � <br />FINAL INSPECTION �a�o '� �/� � �� S�/ � <br />Approved as Constructed -- <br />igna ure o ppT F a e <br />� <br />WORK AUTFIORIZED BY i HIS PERAIR �1UST BE STAFi'i ED WfTFiIN 180 DAYS OF DAlE PERMR IS ISSUED IWD THEREAFTER IS TO HE DILIGENTLY PUASUED TO <br />COMPtEP!NJ. THIS PERMR �1AY B`c C ANCELLFD BY 1HE CfTY UPON ANY STOPPAGE OF WOPo( ON TH�S PROJECT OVER 90 DAYS WFiAT10N. <br />Skz��tt s ° E�cc� V�tioh <br />�ulnGrxble .� s�rcd <br />S�atias bnsew�e�-s, cr� sP �• <br />yYp� �ur;nq (�(�Gride� we� pu-ioc�s. G�ons�(.tion �{-k.hehouses sha�ld <br />��re5s '�nG � '�-�w' por�a�•�� s�b9r�d� w�t��s a�� e��1a� s�b yrzd� <br />�i � <br />dr�,hayc,��r 1a�n�r,�s, �+,�- ���s rc�so� arxw� s�Q�� �h� �o�s�-t;or, <br />yha,l� lae �vo�ded•" <br />� <br />