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6" <br /> h:� <br /> (^ ♦ <br /> Qate <br /> 11/15/83 PublicWor6sPer8i3��` � <br /> eme.oeo+�• <br /> qpplication Po: <br /> Pv ��_IC WORKS PERNlf,� PueTolalFe,�Fee §— �_� <br /> ,.ess nr��.�^e aaie 5�— <br /> Halance Due S ,�-� <br /> Print or Type Only � �g 7 9 <br /> Duiardin Development PO Box 5308 Everett WA 98206 334-5018 <br /> Owner Mailing Address Ci�y Zip Phone <br /> San:e <br /> Applicant Mailing Address City Zip Phone <br /> Describa Proposed Work single family residence <br /> � <br /> Projed tiddress(it known) LOt 9 kY�2xa�g�xxxx�xx 109 East Intercit Avenue � <br /> Attach tour�4) copiea of plans for proposed work• Draw to�cale and note the lollowing as applicable: � <br /> • Proper�y Lines • Centerline of s�reet ♦A <br /> • Outline and dimensions of all exisling and • Indicate Norih V� <br /> proposed s!ruclures on lhe Iet • Show any proposed gradinc� changes <br /> • Existin9 antl proposed utilities • Show measurements � <br /> DU NOT WRITE BELOW THIS LINE � <br /> PERMITCOND:'�IONS <br /> 1. All calls for inspeclion shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be oerformed in accordance with this permil and curreof City ol Everett Design and Consiruction <br /> Standar�s antl Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREt NUMBER 1•800•424•5555. � <br /> 4. Per approved plans signed 12/7/83 and preliminary plat approval 6-79. O <br /> � <br /> V/ <br /> O^ <br /> i�i� <br /> ACKNOWL�DGEA4ENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less �he City ol Everett from any and all claims for damages, costs, <br /> expenses, or causes ot action thal may arise because of installation <br /> and maiNenance ef ihe improvement or other right•ohway use hereto <br /> --�� d applied for and further agrees to remove s2me upon nolice irom the <br /> Approve f r ons ruction Date City an to replace p tr{'c property damaged ihereby. <br /> _ � �( ' �- . <br /> FINAL INSPECTION Dat . � � / ' 2L � <br /> Approved as Construcled Signature of App�' nt Dat <br />\ everctt PUBLIC WORKS DEPARTMENT WORK AUTH9 ftIZE BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 32JOCedarStreet i80 DAYS�F D E PERMIT IS ISSUED AND IHEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGBiJ PURSUED TO COMPLETION. THIS PERMIT MAY DE <br /> Phone: 259-8815 CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> ,,4 <br /> � <br />