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DateZ�18/e6 <br />� <br />Applicatlon Fo� <br />PUBLIC VIiORKS PERMIT <br />Print or Type Only <br />PuEuc Won� parmH � <br />eiau.0eot • 96/16075 <br />Pu��¢ Worb Poa <br />Tot�i Fae = <br />Len �pPl Fee P�IE S <br />Bal�nce Uue � <br />Kathy Dinemore 318 South Cabot Everett 98204 353-5603 <br />Owner Mailinp Address Cily Zip Phone <br />Goode Conetruction 5832 119th Avenue N.E. Lake Stevene 98258 334-5262 <br />Applitanl Mallinp Addresa Clty Zip Phone <br />Conatruct 20'x24' Garage <br />Deecribe P�opoeed Work <br />Prolect Addresa (II known) <br />Attach lour (4) coalee ol plene loi proposed work - Draw to ecale entl nota the lollowing as epplicable: <br />• Froparty Lines <br />• Oulline and dimenelona ol ell exlsting and <br />propoaed elruclures on the lot <br />• Ezlelinp end proposed ulllltlea <br />PERMIT CONDITIONS <br />• Centerline ot etreet <br />• Indicate No��h <br />• Show eny proposed gredinp chengas <br />• Show meeaureTents <br />1. All calls lor Inepecllon ehall be made 24 hra in advence • phona 259•881 5. <br />2. All work ehell be perlormed In ecco�dence with this permit end curranl City ol Everett Deaipn and Conelruction <br />Stendarde and Specllicatlonn <br />3. Call Location Unde�pround Servlca 48 hra before you dIB. TOLL FREE NUMBER 1•800•424•5555. <br />�rSl..iC !i/O,�+F..S ��,eitili% � !1/oi 2c�c�v/,�f� <br />Approved lor Constructlon Dete <br />FINAL INSPECTION Date <br />Approved ee Conatructed <br />everett PUBLIC WORKS DEPAPTMENT <br />� 3200 Cedar Slreel <br />Evere�t, WA 98201 <br />Phone:259�8815 <br />77� r �. ����''6 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />The unde�slgned owner/epplicant hereby agrnes lo hold and seva herm• <br />less the City of Everett irom eny end ell clelma lor demage& coet& <br />BxpBn9B3, of CeUSBe Of BCIIOn that may arlsa beceuse of Instellatlon <br />and melnlenence ol the improvement or other right-ohwey ueb hereto <br />applied Im and lurther egrees to �emove aeme upon notice Irom the <br />Cily end to replace public properry damepad thereby. <br />Slgnature ol Applicanl Date <br />WORK AUTHORIZED BY 1HIS PERMIT MUST BE STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUFD TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />