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Date 3/3/95 <br />Application For <br />PUBLIC <br />WORKS <br />PERMITt <br />R <br />Print or Type Only <br />O <br />7_ <br />a.. <br />O OCIp 0 <br />nootoo <br />M. <br />[ , O D O <br />Patrick Caudle <br />' <br />to <br />ri <br />" <br />79-U <br />Owner <br />ma11..,« oa <br />5 <br />-o <br />'v 775-7Q77 <br />Applicant <br />Describe Pronosed Work <br />Project Address (if known) <br />Attach t Dur (4) copies of plans for proposed work <br />Address <br />Convert SPR to d <br />Public Works Permit <br />Bldg. Dept. r _i, �c c <br />Publlp Work, Fee <br />Total Fee <br />Le„ AppL Fee Paid $ <br />Baal irce Due $ <br />co ^- Rp-� <br />L,v <br />oc. r`lv ooiLJ <br />G'S <br />Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />Proposed structures on the lot <br />• Existing and proposed utilities <br />-322,1-0//83/ <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <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 Cily 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 />C�¢rrv� �'/Gf•a ✓¢� �Dgr,fio5 O Q (/4rC�ci <br />SvisC wipe �f?War /i O�gMcTth <br />S��ti fiaLd far /+Acts L.��Y«i Ci7fi/ (qhL e-A,,Y) <br />Approved for Constr ctlon Datete <br />FINAL INSPECTION Date <br />Approved as Constructed <br />WORKS DEPARTMENT <br />CLPUBLIC <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8810 <br />Cn <br />z9.roF'ItAlf <br />¢edt �`0 60 metern� <br />W <br />z <br />O <br />V! <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any an II claims for damages, costs, <br />expenses, or causes of action th may a because of installation <br />and m e ance o�,b <br />l prov nent o oth r right-of-way use hereto <br />app' d for nd tura ree to re ve ame upon notice from the <br />Ci and to r placei pr party ma ed thereby. <br />Signature of Ap 1 1 Date <br />WORK A THO D BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAY ATE 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 />