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Date 9/8/95 S 3& zel <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />'iS31NG OCT 2 8 <br />Public Works Permit+ <br />Bldg. Dept + 49416 <br />Public Works Fee $ <br />Total Fee <br />Less APPI. Fee Paid $ _-- <br />Balance Due S <br />Al Jubie 1821 19th Dr Mukilteo 98275 290-1456 <br />Owner Malting Address City Zin Phone <br />Owner <br />Applicant Maillnq Address City Zip <br />New house - Basic 1115 <br />Describe Proposed Work - -- <br />Project Address (it known) <br />Q1 - BLDG <br />Attach four (4) copies of plans for proposed work - Drav, to scale and note the following as applicable. PLBG <br />$63.00 <br />• Property Lines <br />• Centerline of street MECH <br />$60.00 <br />• Outline and dimensions of all existing and <br />• Indicate North [; <br />• Snow any proposed gradirt���li+ ps <br />$4,50 <br />proposed structures on the lot <br />• Existing and proposed utilities <br />•Show measurements DRY <br />—^ <br />$20,00 <br />DO NOT WRITE BELOW THIS LINE WATER $650.00 <br />#00030773 <br />PERMIT CONDITIONS SEWER $70.00 <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Desig5l5RMnA 10ibn70 <br />Standards and Specifications. 4970 Q <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800- 4 a $35.00 <br />L} U�J C! �✓� w�cL� �v ei>od ✓wd mew E 55� <br />CHECK $2825.D0 <br />11-9071. <br />/`�� <br />5gC�w,v�� 'ter Wa�Ly'vn�lhf ovt r �l �l /wSi t1t ��; <br />L-0 Li-61 'fmcord <br />Approved as Constructed <br />OLPUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />LU <br />Im <br />O <br />n <br />z <br />O <br />0 <br />O <br />a <br />The undersigned owner/applicant hereby agrees tc hold and save harm- <br />less the City of Everett from any and all claims for damages, costs. <br />expenses. or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Appll t Date <br />WORK AUTHOR ZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />