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� <br /> 0 <br /> L7 <br /> � �Plication For . <br /> PUBLIC WORKS PERMIT oa,e—"� l0-2'-9' <br /> N <br /> PUBLIC WORKS DEPARTMENT Publlc WorNo Pertnit 8 <br /> 3200 Cedar Street W ��7-�� <br /> Everett,WA 9B201 259-8810 <br /> T'� POSTING �N 1 2 � BuildingP�,��« 56919 _ <br /> TYPE OR PRINT ONLY p y� ���S �j - <br /> co. oc000 .-� � � c�° <br /> a_.-ic, o � ino .-iootn in <br /> Just Rite Construction 8015 Beverl �2i� �Ev�ei� 98�(� ?30�3179 <br /> Owner Mailing Address City Zip'i �� ,� Phone <br /> N <br /> [T Y- <br /> OWiler � �.� r..., c� i.� r� .-~. %t <br /> Applirant Mailing Address � J � �� � �-+ � phone <br /> .-� �''� w -r_ cc �� <br /> .-�� :u [,_ .r_ fn c-i 4 tn = f"' <br /> Describe Proposed Work new houae - Basic 1234 � <br /> — � <br /> � <br /> � <br /> PROJECT ADDRESS(if known) 110 Forest Court Lot 2 SP 6-96 � <br /> Attach four(4)copies ot plans for proposed work-Draw to scale and noie the following if applicable: O <br /> •PropeAy Lines 'Outline antl dimensions of all ezisting and proposed structures on the lot •F�cisting and proposed utilities <br /> •Ce�:terline of street •Indicate North •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1.All calls for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2.All work shall be performed in accordance with this permit and cunent City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Undergraund Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> �'� �in�iv� vboE� � o{�ko SEorm dr��n �s�v� �rav�c�ed on lot. (� <br /> J O <br /> � a <br /> , <br /> ` � <br /> ; <br /> ACKNOWLEDGEMENTOFCONDITIONS I <br /> ___/��'t-"�' � /��/� / The undersigned ownedapplicant hareby agrees to hold and g�ve hartnlass <br /> � � the City of Everett}rom any and all claims for damages,costs,expenses,a <br /> Appr�oved fW Const�on p e causes ot action that may arise because of installation and malntenance of <br /> the improvement wother rigMof-way use hereto applied for and turther agrees <br /> to remove same upon notice from the City ani to replace public property <br /> ���� damaged t reby. <br /> FINAL INSPECTION Date � <br /> Approved as Constructed � <br /> �f L <br /> ( nature of Applirant p�e <br /> �NORK AUTHORIZED BY THIS PERMIT MUST BE STAFiTED WI7HIN 180 DAYS OF DATE PERMR IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CI1V UPON ANY STOPPAGE OF WORK ON iHIS PRQIECT OVER 90 DAYS WRATION. <br />