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Date l0/17/85 <br />Application For <br />PU�LIC YVORKS P�RMIT <br />Print or TyFe Only <br />Pu�i¢ WorMe Vermlt • <br />aieo oso�.. SS/15595 <br />Pubt.c Woru Fee s <br />Totei Fee <br />Le>s Appl Fee Pa�O S <br />Belence �ue S <br />Robert Hereford 5605 Beverly Lane Everett 98204 353-7356 <br />Owner Mailing Address Ciry Zip Phone <br />Pac-West Constructior. 10929 Highway 99 South Su.ite-C Everett 98204 347-1491 <br />Applicant Mailing Address Cily 2ip Phone <br />8'x17' addition, and remodel kitchen area <br />Doscribe Proposed Work <br />56G1 Beverly Lane <br />Pru�ect Address (if kni:wn) _ <br />Altach lou� (4) copies of��lans for propos��d work - Draw to scale and note ihe Ioilowing as applicable: <br />• Property Lin\ <br />• Outline and dirt:ensions ol all existing and <br />proposed strudures on the lot <br />• Exlsling and proposed utililies <br />• Centerline ol sireet <br />• Indicu�e Nor�h <br />• Show any proposed prading chenges <br />• Show measurements <br />PEflM1T CONDITIONS <br />1 All calls for inspeclion shall be made 24 hrs in advance - phone 259•881 5. <br />2. All work 5hall 6e perlormed in accordance with �his permit and current Cily ot Everett Design anA Conslruction <br />Standards and Specitications <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�i��G �Gi?,P.f3� �``,Pi;��% /..!%T <br />Approved lor Construclion ���e <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar SVeet <br />EveretL WA 98201 <br />Phone: 259�8815 <br />Date <br />�� <br />��QG%�2�� <br />�/ v <br />/G�� p�! <7 S <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />The undersigned owner/applicanl hereby agrees to hold and sa.a harm• <br />less the City of Everett Irom any and all claims lor damages, cosls, <br />ezpenses, or caases ol action ihal may arise because of installation <br />and mainlenancP ol !he improvemenl or other right-ol-way use hereto <br />appiied lor and lurther a�rees to remove same upon notice Irom the <br />Cily and �o replace public properry damaged Ihereby. <br />ol Applicant <br />Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAVS OF DA7E PEFiMIT IS ISSUED AND TH[REAFTER 13 TO <br />BE DILIGENTLY PUR3UED ?O COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPCN ANV STOPPAGE OF WORK ON THIS <br />FROJECT OVER 90 DAVS DURATION. <br />z <br />0 <br />--1 <br />� <br />n <br />m <br />.. .. <br />--1 "T1 <br />.-i -i <br />N S <br />m <br />co <br />m� <br />om <br />s -Z�1 <br />m <br />o z <br />a -+ <br />rx <br />�. .. <br />—� N <br />-< � <br />O A <br />� <br />-� m <br />m �+ <br />N <br />or <br />c� <br />3 Vi <br />m <br />�m <br />� <br />s <br />a <br />z <br />-� <br />� <br />N <br />Z <br />0 <br />� <br />n <br />m <br />