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rr <br />Date9/28/9D <br />r <br />PUB) -IC <br />O <br />Print or Type Only& <br />John 6 Marvwia Ginhb <br />Applicant <br />-T- i `zF --I <br />Application For <br />WORKS PERMIT <br />C]pp? V'1 O O D' <br />t•? {O O I , .} O G In <br />M M <br />d <br />rd 21 W.!;beech EVerett <br />` xf&l R <br />(Idp r;S6 City <br />J�4JJ�iU=J �p�0W <br />6]2 6] br In� <br />_Ilg2n a r r.; t,cnn cvprerr <br />Mailing Address City <br />Describe Proposed Work New single family residence_ <br />Project Address (if known) 17 W Beech <br />98203 <br />Zip <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable <br />Public Works Perm,- <br />• /��=►1� ..,__ <br />ems Dept. a—90125707 _ _ <br />Public Works Fee <br />Total Fee S <br />Less Appt Fee Paid s <br />Balance Dui S <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measuremerls <br />353-4430 <br />W <br />m <br />PERMIT CONDITIONS O <br />1. All cells for inspection shall be made 24 hrs. In advance •phone 259. 81 O. <br />j' ,.All work shall be performed in accordance with this permit and curve t Ity of Everett Design and Construction <br />Standards and Specifications. <br />a Call Location Underground Service 48 hrs. before you dig. TOLL FR E UMBER 1.800-424.555 /•T—`�� <br />3 ��P �� r�01 � <br />�Q � \� U <br />/'J` <br />/ ACKNO LEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />. less the City of Everett from any and all claims for damages, costs, <br />expenappps, or causes of action that may arise because of installation <br />and rn Fiance of the Improvement or other right-of-way use hereto <br />apple for and further agrees to remove same upon notice from the <br />Approved for Construction Date City a d to replace public property damaged thereby. <br />FINAL I TION Date <br />AppluaiDd as strutted Signature Alit Date <br />ev.•rea PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 99201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259.8810 PROJECT OVER 90 DAYS DURATION. <br />