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'} ;?C `� 'r .�;c�:.,: , ti . t srar � _ t � �,.: <br />�".' - . < i a. 3 <br />v ";r,„ � - ;i P ' . <br />:::��` re-i�. .. �` _ .. .. <br />Date B�Z9�84 <br />Application For <br />PU�LIC W�RKS PEF�MIT <br />Print or Type Only <br />D.G. Brandvolo 5307 139th Avenue S.E. <br />Mailing Address <br />SnohomisY. <br />Public Works Permit s `� � , S <br />eie9.oaa�.+ g4/13837 <br />PublicY/oeksFee s <br />Toial Fee <br />Lees AppL Fee PeIE $ ^ — <br />BalanceDue $ �� �/�� <br />�503 <br />98290 568-9342 <br />2ip <br />Same <br />Applicanl Mailing Address City Zip Phone <br />Construct Single Family Residence <br />Describe Proposed Work <br />Project Address (if known) <br />Attach tour (4) copies ot plans tar proposed work • Draw to scale and nole the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Ind�cate North <br />proposed structureS on the lot • Show any proposed grading chan9es <br />Y Existing a�d proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall he pertormed in accordance with lhis permit and current City of Everalt Design and Conslruction <br />St2ndards snd SpeciFications <br />3. Call Localion Underground Service 48 hrs. I�elore you dig. TOLL FREE NUMBER 1•800•424-5555. <br />� • G[.�-c�n� s-r�c� i��i�Y <br />FINAL IN.iPI <br />Npproved as <br />everett <br />� <br />Cj � �[�sCE /���Yfrt�I C GL g� bV�� SC—vx Q pf}"%Ti� <br />. <br />PUB�IC W09hS DEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA 98201 <br />Phcne: 259-887 5 <br />�i:.» .� � �,41 _ . <br />�, e ., <br />� �ry <br />.ry :BYF . - .. . <br />r : <br />Date <br />Date <br />w <br />� <br />� / <br />f� <br />O <br />� <br />r! <br />Q <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Thc undersic�ned owner/applicant hereby agrees to hold and save harm- <br />!ess th� Gty of Everett from any and all claims for damages, costs, <br />eapenses, or causas ot action that may arise 6ecause ot installation <br />and maintenance of the improvemenl or other right-ohway use herelo <br />a � d for and further agrees to remove same upon notice trom the <br />ity a d to replace pu6lic �roperty damaged thereby. <br />SignaWre of Ap�ant � � Date � <br />WORK AIITHORIZEO BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAY i OF DATC PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFiht1T MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE Or WURK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />� <br />H <br />n <br />t�7 <br />H H <br />�j T <br />M �� <br />� <br />�� <br />� � <br />zy <br />Fyx <br />K � <br />O � <br />[*7 H <br />� <br />� <br />� <br />.� <br />� <br />� <br />H <br />4� <br />y <br />H <br />n <br />� <br />