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� APPlicalion For <br /> PUBLIC WORKS PERMIT oa�e 1/17/96 <br /> PUBLIC WORKS DEPARTMENT Public Warks Permit 8 �O LO <br /> 320G Cedar Street <br /> Everett,WA 98201 259-8810 Building Permit p ,Spy� — <br /> TYPE OR PRINT ONLY ��q �pSTi N G ��_----- �ubiic Works Fee$ 7 b <br /> Gaffney .Iim 1715 100th P1 SE Everett 98208 338-7.ii�: <br /> Owner Mailing Address Cily Zip Phone <br /> Same <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work New house � � 1 <br /> iii <br /> � <br /> .�� <br /> / �/ � � <br /> PROJECT ADDRESS(if known) 6416 Elliot Way (�oG Z �P �Z('�s � <br /> Attach four(4)copies ot plans tor pro��osed work-Draw to scale and note the tollowing if applicable: O <br /> •Property Lines 'Outline and aimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br /> •Centerline ef street •Indicate North •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMITCONDITIONS: �/15/96 1�08PM QOOR�445 � `' <br /> 1.All calls for inspection shali be made 24 hours in advance- phone 259-8810. / O <br /> 2.All work shall be performed in accordance with this permit and current City of fqgg��sign and <br /> Construction Standards and Specifications. ELt�; R627.bD <br /> 3. Call �ocation Undergrour�d Service 48 hrs. before you dig. TOLL FREE NUM�E.�;t-800-�4;�• H <br /> M:CH fb0.00 � <br /> SRCHFG $4.5t� <br /> D4IVW�' 'b�Q.OU O <br /> FLF1 CH �46.4? <br /> k00030491 � <br /> SEWER �70.00 <br /> SVSDEV F1296.00 <br /> CHEC4; ;2:P7.5?. <br /> 3� F.CKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agrees to hold and save hartn�ess <br /> Z,? G/ 1he City ot Everelt from any and all claims for damages,costs,expenses,or <br /> «� causes of action that may ar�se because of installation e.nd maintenance of <br /> App vedlorCon �ction ���e theimprovementorotherrighbof•wayuseheretoappliedforandfurtheragrees <br /> to remove snme upon notice from tha City and ;o replace pu6lic property <br /> � j;�`� G ^ 3_ �� damagedthereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed `/ � — <br /> � <br /> S n uro of Applic� t � � a e <br /> COMPLEfION.TIH 5 P RMIT MAY BE CANCEU.EDTBYTHE Ci7YfJPON ANY S�TO PAG OF VJORK ON THIS PROJEC OVER IS�S DUF1AT10N.Y PURSUED TO <br />