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Date-- -- � '�Z5 " 3�0 �Z �4 6��/ <br /> 6/3/92 3' <br /> 3� , <br /> � . �OSTI�VG T /� � z <br /> � nns IN('7 J,`�� Pu�licWaikaPermlt� / <br /> Applicatlon For � eieo oeP�.. <br /> PUBLIC WOF�KS PERMIT PublrcWorbFee . <br /> Total F.e S <br /> � � - . � Less Appl Fae Pe1U S <br /> Print or Type Only , � ea�a��oo�a s Z�� <br /> „ <br /> Steve Goetz 610 Front St ,y406 }tiEIE3F Mukilteo' 98225 355-2842 <br /> Owner Meiling Atldress � , ��� �Ciry � �, _ ZiP Phone <br /> � <br /> Gary Price 355-0639 ' ' <br /> Applicant Mailing Address Gty Lp Phone <br /> Describe P�oposed Work New house <br /> Project Address�if known) ��.7� �� LVZ_ ,� � <br /> Aflach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <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 <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspectiun shall be made 24 hrs.in advance•phone 259-8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current City ot Everett Design and Construction <br /> Standard:and Specificatfons. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-$00-424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> �� ACKNOWLEDGEMENT OF C(?tJDITIONS <br /> The undersigned owner/applicant hereby ag�ees to hold and save harm- <br /> less the City of Eve�ett Irom any and all claims for damages, costs, <br /> __�LI.�/��Ci�.�/` f9 �7- 9Z expenses. or causes of action that may arise 6ecause of installation <br /> � and maintenance oi the improvement or other right-ol�way use hereto <br /> applied lor and lurther agrees to remove same upon notice irom the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> c���LC/L '� � 3- S j i � � —- - <br /> � <br /> FINAL INSPECTION Date �— � C-L�l��� �2�-c-� <br /> Approved as Constructed Signature ot Applican Dale <br /> �� PUBLICWORKSDEPARTMENT WURK AUTHORIZED BY THIS PERMIT MUST BE STARTED W�THIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE UILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BF <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY ST� 1PPAGE OF WORK ON THIS <br /> PROJECT OVER 30 DAYS DURATION. <br />