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I ' o <br /> Application Far m / I <br /> � PUBLIC WORKS PERMIT Dat� 5-9-97 <br /> PUBLIC WORKS DEPARTMENT Pub�,Works Permit x __�S� <br /> 3�00 Cedar Sireet W <br /> Everett,WA98201 zss-es,o MAY 2 6 1998 BuilUg Permit p 55070 <br /> 1YPEORPRINTONLY �� POSTING �--�� PublicWorksFeeS�Q)� <br /> Nq �igg �igag g � � <br /> Thomas Matuszewski 14604 Si�qn ��:$D'f �QE��Q$i',ta98 � 3 2639 <br /> Owner Mailing Address � City p Phone <br /> (� [� (� ¢ <br /> P 2 Z M � Y <br /> Owner '� '" .~. � <br /> Applicant Mailing Address .. ..Cit .r 'p Phone <br /> �s � 3"� � s � s s f' <br /> Describe Proposed Work new house � ■ ■ <br /> W <br /> �"' <br /> � <br /> -- � <br /> PROJECT ADDRESS(if known) 5024 El Charlee St � <br /> Atlach lour(4)copies ol plans for proposed work-Draw to scale and note the following if applicable: O <br /> •Property Lines `Outline and dimensions of all existing and proposetl structures on the lot •Existing and proposed utilities <br /> •Centerline ot street •Indicate North •Show any proposed grading changes •:;how measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2. AII work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL fREE NUMBER 1-800-424-5555. � <br /> V♦ <br /> O <br /> a <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersi9ned owner/applicant hereby agrees to hold and save harmless <br /> • �/� ��R� � � — the City of Everett from any and all claims for damages,costs,expenses,or <br /> � � causes of action that may arise because ol installalion and maintenance of <br /> ApprovedforCo ructio Date theimprovementorotherright-of•wayuseheretoappliedlorandfunheragrees <br /> to remove same upon notice from the City and to replace public property <br /> �� _f 0 damag thereby. <br /> FINAL INSPECTION Date / ry � <br /> Approved as Constructed O� /}�-- <br /> ii�p� <br /> Signature of Applicant Date <br /> WORK AUTHORI2ED BY THIS PEPMIT MUST BE STARTED WITHIN 1B0 DAYS OF DATE P=RMR IS ISSUED AND THEREAFTER IS TO BE DILIGFNTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGL JF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />