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Uate z�23/94 <br /> � 9 /D 3 <br /> � ( �� CJ a�oeo wo,x,a9,�� <br /> J + <br /> AppliCation For e�ae�o«.:� ._ <br /> PUBLIC WORKS P�����N� PubiicWorkeFee s — <br /> 'I`��—^ �f TotalFae <br /> �Y less ADOi Fee PeiE S <br /> Print or Type Only � � $ g g �j g g ' ao�a S 20 _ <br /> .�+ M M�— +R � CJ If! � 1f2 O <br /> M N � � <br /> Fairmont Homes Inc 21902 38th Ave W Brier 036 353-24 � <br /> Owner MaiVing AtldreSs O� `� M City Tu i r�1 � Phone <br /> Same ra � 833� � � � � � � .�, CS - . <br /> Applicant Mailing Address City Zip Phone <br /> New house <br /> Describe Proposed Wark <br /> ProjectAdtlress(if known) `"Tv7� ����GL ��� � Lot 2 Black Forest Ln � <br /> Attach fow(4)copies ot plans for proposed work- Draw to scaie and note the following as aGP��cable: � <br /> i Property LineS • Centerline of street /� <br /> • Outline and dimensions of all existing and • Indicate North V/ <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements _ � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS . <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•asl�. � <br /> 2.All work shall be performed in accordance with this permit and current City ot Everett Design and Construction <br /> � Standards and Specifications. <br /> 3.Call Location Underg�ound Service 48 hrs,before you dig.TOIL FREE NUMBEH 1-$00-424•$555. � <br /> 9.� a'.-�,� 'ti y�ea2� �,u' ,h`.�,�t' �""`GBuz�` <br /> .t�-� -a.4.0a. �- �-u�- O <br /> ,��iZ.i� �z-i(., i'-�.P�d.�ize.r� � i� � <br /> �387 T�+�on� Co)vGt�e� �xti�:tlGu2cy- • V♦ <br /> (/ <br /> O <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �� The undersigned ownedapplicant hereby agrees to hold and save harm- <br /> less the Giry of Everetl from any and all claims br damages. costs. <br /> evpenses, or causes of ac[ion that may arise because of installation <br /> l��i �/y�C[/ „ � �_�G� and maintenance of the improvement o:other righ[-of-way use hereto <br /> Y /�� ���� � apFlied tor and furthe� agrees to remove same upon notice from the <br /> Approved for C st/ru/�j on �a�e City and t place publir,property damagetl thereby. <br /> �L�Gc"`�-�.. ��. �. f� ._ i '�/ <br /> FINAL INSPECTION � Date <br /> Approved as Constructed Signat plicant Dat <br /> PUBLICWORKSDEPARTMENT `�`10FtK A O 12FD BI THlS PERMIT MUST BE STARTED WITHIN <br /> I 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStreet BE FJILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY TNE CITY UPON ANV STOPPA6E OF WORK ON THIS <br /> Phone:259-8810 I PROJECT OVER 90 DAYS DURATION. <br />