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� �aication For -/ <br /> PUBLIC WORKS PERMIT oete 11-11-6-96 <br /> PUBLIC WORKS DEPARTMENT Publlc Nbrks Permlt M _ <br /> 9F 44 -- <br /> 3zoo caaa�scree� <br /> Evoretl.WA 98207 z5s-eaia Builtlinp ParmB N 53436 __ <br /> TYPE OR PRINT ONLY TO POSTI N G � �' e � Public Nbrks Fee S�C O b — <br /> .....n <br /> Robert Brokaw PO Box 254 Everetl• WA 98206 259-6543 <br /> Owner MalNng Adtlress City Zip Phone <br /> Owner <br /> Applicant IAnlling Address Ci�y Zia Phone <br /> Describe Proposed Work _ new house ■ . ■ <br /> W <br /> - -- � <br /> � <br /> - - � <br /> PROJECT ADDRESS(it known) _ �126 Chinook Dr T.ot 10 Seabrook Hi hlande � <br /> Attach fom(4)copies ol plans br pmposeQ worM-Draw to scale antl note the Iollowing II applicable: O <br /> �PropeNy Lines �Outline end dimensions ol all azislinq end proposed structures on���a lot �Existing end proposed utilities <br /> •Centedine of slreet •Indicate North •Show eip�proposed groding changes �Show measurements � <br /> DO NOT WRITE BELOW THIS LIP1E <br /> PERMI'f CONDITIONS: <br /> 1.All calls for inspoction shall be r�iade 24 hours in advance- phone 259-8870.1?/11/96 1:2QFN �]OO�qB99 <br /> 2.All work shall be performed in accordance with this permit and current Cit�o'Everett Design and <br /> Construction Standards and Specitications. H0005'436 <br /> 3. Call Locatlon Underground Service 4B hrs. before you dig. TOLL FREE MUM�i 1-800-�.6d5b. � <br /> fLE�i ft05.00 <br /> 4 �C::���,G c T f�r .�'�'iS�o� Si7<< PLn/7 SC�6/a .��� , ���E O <br /> D6'IVWV S:'0.00 <br /> q00009^15 /� <br /> 1JqTEF S.O5.0� Ii <br /> RD0030908 <br /> SEWER l70.00 <br /> S1'SOEV 5,613.OD <br /> CHECI; 43�39 00 <br /> � ��: <br /> / �/� <br /> ACKNOWLEDGtMENT OF CON[11TIONS <br /> �l /1� / /� o� The undarsigned ownrriapplicant hereby agraos to hold and savn hermless <br /> �-. I the City ol EvereB!rom eny ond ell claims lor damages,cost9,ezpanses,or <br /> Approved lor Const � n Da couses ol acUon that may arise beceuse ol Installatlon and malntenance o1 <br /> � the impro�•nment or othel right-ol-way use haeto applled lor end further egreea <br /> to remove same upon notice from the City end to replace public property <br /> ,�.���- �_Zt�.�7 tlamaqedthereby. <br /> FINAL SPECTIONI D.te <br /> Approved as ConsVuc�ed <br /> Signalure of Applicant Date <br /> WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAV BE CANCELLED BY THE CITi UPON ANV STOPPAGE OF WORK ON THIS PR0.IECT OVER BO DAYS DURATION. <br />