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S-3S-Z`I-� � � <br /> Date�? T� ^�C7I��. � PUEIIc Worke Parmil r � � <br /> • , Application For � <br /> �' 1�.._ �"��� eiag oani . 36221 <br /> PUBLIC WORKS PERMIT PueTo�FeeFeo s <br /> � �ess noot Fea va�a S �j <br /> � i � � . � Balance Due S rD <br /> Print or Type Only . � , �• , � — <br /> � , � , <br /> � � iT'I L� <br /> ,—.� . a0 � . ... .. . ' <br /> [ I <br /> Carlstrom, Rand ��� 121 W�'Ninesa Bothell 8012 672-6909 <br /> Owner �-. �r', �'� �� �Mailing ddress - : CitY Zip Phone <br /> f, ri i : ir, � � . I,i <br /> �, . �,� ' �� � � � , <br /> Tutmarc Assoc' � 4909 119th1+P1 NE Kirkland 98033 827-6561 Greg Andrews <br /> Applicant Mailing Adtlress City Zip Phone <br /> Des�ribe Proposed Work new house <br /> W <br /> Prolect Address(if known) <br /> 1609 En land A ' L'�f s �20Z� �8'8S � <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> � Property Lines • Centerline ot street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on lhe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show me25urements M <br /> W <br /> �� DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls tor inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shell be performed in accordence wilh this perinit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> . � <br /> � <br /> O <br /> a <br /> �.JJ1/� ACKNOWLEDGEMENT OF CONDITIONS <br /> Llj._J <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> � less the City of Everett Irom any and all claims for damages, costs, <br /> ��`� � _,� —� �' expenses, or causes of acP n that may arise because of installation <br /> and maintenance of the im rovement or other right•of-way use hereto <br /> applied for and further agrees to remove same upon notice Irom the <br /> Appr ved tor Con tru� Date City and replace public pr erty damaged ihereby. <br /> . � 30 l� ? <br /> FINAL INSPECTION �a1e Date <br /> Approved as Constructed Sig ure of pplicant <br /> K AUTHORIZED BY THIS F'ERMIT MUST BE STARTED WITHIN <br /> ���� PUBLICWORKSDEPARTMENT 0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Sireel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•E810 PROJECT OVER 90 DAYS DURATION. <br />