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Date 6-21-95 <br />� qpplication For <br />Pl16LIC WORKS PERMIT <br />Print or Type Only <br />TO POSTING � 0 3 '�' <br />/ � <br />PubLCYJoeksPerm�tv L��� �'O <br />eioy. oeo�. • 48671 <br />Pu�:¢ Wm�s Fee <br />Toial Fee $ <br />Ln55 ApO�� F✓e PaA S �j^• <br />BAIdnCP �UC �J �/`� <br />Leonard Astemborski 3723 Wetmore Ave 11A Everett 98201 266-3563 <br />Owner Aqailing ��:dres5 Gty Zip Pnone <br />Owner <br />APpI cant <br />rn;w.,:; Atldress <br />Zip �none <br />Describe Proposed Work new hOUse______ ___ _ <br />Project Address �if knownl 1430 Madrona Ave ___ _ <br />Attach four (4) copies of plans to� nroposed wurk � Dra�e to scai�� ann note the !oticrnng �s apulicabie; <br />• Property Lines <br />• Outline and dimensions of all exishng antl <br />proposed structures on Ihe loi <br />• Existing and pwposed utilities <br />,�a� <br />• Ge.nterline of stree� <br />• Intlir.ab= North <br />• Sho�v any prOpoSeA qratling chanyes <br />• Show measureinen�s <br />�ERMIT CONDITIG?!S <br />1. All calls tor inspectir. � shall be mada 24 hrs. in advance • phone 259•8810. <br />2. All work shali be perfermed in acwrdance with this pe-mit and current City of Everett Desi9n and Conetruction <br />Standards and Specilications. <br />3. Call Location Undery,ound Service 48 hrs. before you dig. TOLL FREE NUMBER �-800-424-5555. <br />"T � �l� � �� n e �Df o�T'�r �'h f � `' C/3 �v, �(%✓-�'�2.i1,, .�" �r,-`� <br />�, S✓ �ZSeuX%f /�'/uJ f � �v � � l i� ,�/v /� �� l'�i Gj ii `� a ��,,.i"""� <br />0 U <br />L✓,-�f �„ G/�'G✓� Ov� G� pr'OrPQ-/'� �/l�e. �n ��, "�'7 <br />/ V <br />be 4�� u,� �v.-, �vhfc �rzi�o, ��� s-f-�l � G D l. <br />ACKNOWLE�G[MENT OF CONDITIONS <br />�—��G��- �/2 �: <br />ApFruved lor o truction ate <br />��_ = �=-� �-s� <br />FINAL INSPECTION Date <br />qpprovea zs Construded <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Stree! <br />Everett, WA 98201 <br />Phone: 259-8810 <br />W <br />� <br />N <br />� <br />O <br />r <br />N <br />O <br />a <br />The under�igned owneqapplic<nt hereby ag�ees to hold and save harm- <br />less tl��a Gty ot Everett Irom arp• and all claims for tlamages, costs. <br />exUenses. or causes of actlon that may arise because of installation <br />and mamtenance ol the improvement or other right-of-way use hereto <br />apN�nd for and further agrees tu remove same upon notice hom tY�e <br />C�!y ,�ntl to replaca public proGerty damaged thereby. <br />�,,,�,,,� (� _ ��,,,,�. ��c/�— <br />Signature of Applica Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />190 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED 6Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.IFCT OVER 00 DAYS DURATION. <br />