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it <br />Date 8/ 19192 - - -1) 7 T!.9 flby Public Works Permit • � / <br />' Bldg, Dept. e 37754 <br />Application For <br />Works Fee <br />PUBLIC WORKS PERMIT PeETo $ <br />Tc Fee <br />alFe <br />Lesa Ao t Fee Paid IB <br />y <br />_r r IM r-J fJ r t_ r- <br />n r r rS o t I o rJ eal.ric6 P e! S <br />Cx�] <br />Print or Type Only a In n .;; a•. <br />cc 7 rf'7i:t .v+; o)vi ro,l i0v -t <br />o c�NH�� <br />e4 . LF G, <br />L9r xL' <br />Withers Construction Inc .2)Fu Soh Avp�SA R rh 11 aDim? 1 '0'301 450[ <br />H z H <br />Owner 4: ing Atldfe,SF� z o W o6ltyeo : __ Z -:a k�i 4l t+ .-+ a Phone <br />b.l <br />fJ ui ot`� o r_Y w r_r rn� o _ n <br />J Lt _J ._.I W ry: O Q <br />1.4 <br />Bob Withers Same as abcvr_ <br />Applicant Mail Address City Zip Phone <br />V] t-1 <br />(A H <br />S <br />qz <br />OHO <br />New house <br />Describe Proposed Work <br />O H <br />IV <br />000 <br />zy <br />W <br />l� <br />kno.vn)ARM NrA i 'S ,A2 sT� T <br />Project Address (if — <br />tttyyy D <br />Cr [0 <br />Attacn four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: t� <br />• Property Lines • Centerline of street rgg <br />• Outline and dimensions of all existing and • Indicate North NY <br />H1-33 to <br />proposed structures on the lot • Show any proposed grading changes <br />-� <br />• Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. earq <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction ./ <br />Standards and Specifications. <br />V,,as. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424-5555. <br />iMillif, <br />�I <br />G <br />0 <br />Uj <br />O�oo <br />as <br />JZnn <br />ACKNOWLEDGEMENT OF CONDITIONS <br />rY The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes ofa action that may arise because of installation <br />fl /f f L•-(/p_�'"J Y and m ante of the improvement or other right-of-way use hereto <br />apDu d to and lurthe agrees t remove same upon notice from the <br />Approved for Consir 1'on Date C y an o repla e p lie proper damaged thereby. <br />FINAL INSFECTION Date <br />Approved ac Constructed Sig of Aipi nt Date <br />WORK AUTHORI D BY THIS PERMIT MUST BE STARTED WITHIN <br />j` 7 PUBLIC WORKS DEPARTMENT 180 DAYS D TE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY <br />TL <br />vr Everett, WA 98201 IS <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TIiIS <br />Phone: 259-8810 PROJECT OVER 90 DAYS DURATION. <br />