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Date �����QZ � PuElieWork�Permlt• <br /> � ApplicationFor eieo.osa�.• 92/35h61 _ <br /> PUBLIC WORKS PERMIT PuDTo�dFeaFae s _ <br /> Laes A00�Fee PaiE S <br /> Balence Oue t <br /> Print or Type Only <br /> .Tudith Faulhauber 814 Crown Dr Everett 9A203 259-0512 <br /> Owner Ma6ing Address Ciry Zip Phone <br /> Broderi�:k Architecta 701 Dexter Ave N 11215 Seattle 9a109 283-5209 1i4535. __ <br /> Applicant Mailing Address G.ty ZiP Phone <br /> DescribeProposedWork crn ^'�ifinna <br /> __ W <br /> Pro�ed Address(if know�l _$14 Grown Dr. — � <br /> Attach tour(4)copins of plans tor proposod work-Draw to scale and note the�following es applicable: � <br /> • Property Linea • Center�ine of street � <br /> • Outline and dimenaions ol all exisling and • Indicate North <br /> proposed structures on the lot . • Show any pronosed grading changes <br /> • Existing and proposed utilities • Show oi�asumments � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls tor inspection shell be made 24 hrs.In advance-phone 259•8810. � <br /> 2.All work ehell be perfo��.aC in accordance with this permit and curtent City ot Everett Design end(:onstruction <br /> Standards end SpecHications. <br /> 3.Cell Location Undnryround Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�4245555. � <br /> r O <br /> /v� c�o�-��.,�,� /l,bz��c��:,�,�,� � <br /> �� � <br /> a ia�92 O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIO��S <br /> The undersigred owner/applicant hereby agrees lo hold and save harm• <br /> les. the City of Everett irom any and all claims for damages, costs, <br /> ozpenses, or causes ol ection lhat may arise because ol installation <br /> and maintenance of the improveme�t or other righl-of•way use hereto <br /> applied for and lurther agrees to remove same upon notice trom the <br /> Approved for Construction �e�e City and to replace public property demaged thereby. <br /> FINAL INSPECTION Dete ' Date <br /> Approved as Constructed Signature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � PUBLIC WORKS DEPARTMENT , 180 DAYS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CederStreet ` BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> EveretL WA 98201 I GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8870 I PROJECT OVER 90 DAYS DURATION. <br />