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vF.,-... ��::n.. <br />Date B�z9�84 <br />Application For <br />�'UE�LIC W�DFiKS PERMIT <br />Print or Type Only <br />Pu�lic Works Permi� X V� �G � <br />Bldg. Depl. • $4/138 6 <br />Pu01ic WorY.s Fea $ <br />Totel Fee <br />Lesa AOP� Fev PaIE $ <br />o�ie.,�a o�a S ZU' - ��i <br />�so3� <br />D. G. Hrandvold CorQ. 5307 139th Acenue S.E. Snohomish 98290 568-9342 <br />Ownor Mailing Address City Zip Phone <br />Same <br />Applicant Mailing Address City Zip Phone <br />Construct Single Family Residence <br />Describe Proposed Work — <br />Projec� Addrass (if known) <br />Lot 3 <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Properry Lines • Centerline of s�reet <br />O Outline and dimensions of all existing and • Indicate North <br />proposed struclures on the lol • Show any proposed grading changes <br />• Exisling and proposed utililies • Show measurements <br />FINAL INSPI <br />Approved as <br />everett <br />� <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in adrance - phone 259-8ci1 5. <br />2. All work shall be pertormed in accqrCance with �his permit and current Ciry of Everett Design and Consiruction <br />Standards and Specifica!ions. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NV6�CER 1-800-424•5555. <br />`"I . C L E Fk1,1 <br />5. P��� <br />s�� pAr�. ,✓ <br />F I tJ F} [_ pF��ld- <br />('/�-�� <br />Date J <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259•8815 <br />. ��... � -' . . <br />x <br />.,.,"-:�,. �, "� ��... <br />-�i,.- _.. _ <br />ovC-� S�uIE� <br />� <br />0 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees lo holti and save harm- <br />lass the City of Everett from any and all claims for d�'�ages, cosis, <br />expenses, or causes, of action that may arise hecause of installation <br />and maintenance of the improvemenl or other right-of-way use hereto <br />applied tor and further agrees to remove same upon notice from the <br />and to replace public �roperly da/rp�)ged thereby�. /' <br />�. ! / ,e n,. . /1' 1_1....�.�. if/ �—.� �?�� ! / l O / �I� <br />Signature of ApU��cant / IIGIC <br />WORK AUTHORIZED BV�THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AN9 THEREAFTEIi IS TO <br />BE DIL!�.�ENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BF <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />H H <br />h h7 <br />H �� <br />� <br />O � <br />�z <br />r� <br />HF� H <br />K � <br />� � <br />� H <br />p � <br />` i �j <br />�N <br />� <br />� <br />� <br />� <br />� <br />H <br />n <br />m <br />