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10/16/85 • • I Frplic Works Permi� t _— <br />Date 85/15586 <br />BIEB� Dept. r <br />Application For <br />�UBLIC WORKS PER�VIIT <br />Public Works Fea <br />Tolal Fec $ <br />Less Appl. Feo Paid $ <br />6alanca Duo � <br />Print or Type Only <br />Rebecca M. :Cing 6531 Lombard Everett 98203 355-2003 — <br />Owner Mailing Address City Zip Phone <br />Same <br />qpplicant <br />Cescri6e Proposed Work <br />Project Address (il known) <br />Mailing Address <br />City Zip Phone <br />13'x18' Addition to existing residence <br />Altach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines O Centerline of sVeel <br />• Outline and dimensio�is of all existin9 and � Indicate Norih <br />proposed structures un the lot . i Show any prop�. rsed grading changes <br />• Existing and proporad utilities • Show measuremeNs <br />LINE <br />PERMIT GONDITIONS <br />t. All calls tor inspection shall be made 2a hrs. in advance - phone 259•881 5. <br />2. All worl; shall be performed in accordance with ihis permit and curreN Ci�y of Everetl Design and Construction <br />Standards and Specifications. <br />3. Call Location Underyreund Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800•424-5555. <br />/L � /li"J.��t � l � �:. j f _< �C =,/,'.�l.�s <br />�G i �7 � <br />//°` /i; i��=�r <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett � PUBLIC WORKS DE."ARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98207 <br />Phone: 259-8815 <br />� f' c�'L �/%-� � <br />/L , /L� i.� J <br />ACKhOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less lhe City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action ih �t may arise because ot installation <br />and maintenance of the improv� nt or olher right-obw.�y use hereto <br />applied for and �urther agrees _.emove same upon no'ice from the <br />City and to replace public properry damaged Ihereby. <br />Signature of Applicant Date <br />WORK AUTHORIZ[D BY THIS PERMIT MU�T DE START@D WITHIN <br />180 DAYS OF DATE P[RMIT IS ISSUED AND THEFiEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />