2209 COLBY AVE 2018-01-02 MF Import

I Balance Due $ Print or Type Only ALBERT C HEIDE 2209 Colby Ave, #3 Everett Wash.98201 252-43347 Owner Mailing Address City Zip Phone same as above Applicant Mailing Address City Zip Phone Describe Proposed Work See on adjacent blue print. W Project Address(if known) 1.111111 Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: mom • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North CI) proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. 4. 5 re./ ��p .r SA- %e." t/Zzl13 O H 0 a tP-1 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, costs, • expenses, or causes of action that may arise because of installation and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the Ap ov for Con uc ' to City and to replace public property damaged thereby.