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! Public W�rks Permi s � r -- <br /> Date�LS/8 3 eiao 000�.• 8 3/1 6 9 3 <br /> App!ication For <br /> PUBLl/� WORN:S PEFiMIT PUCGCWarksFee o _ <br /> Ta1el Fes $ ` <br /> Loss ApO�Fae PaiO S �_._�--�— <br /> 9alanco�ua ^d <br /> Print or Type Only 6 Jo7:�, <br /> DUJARDIA] DEVELOPDIENT PO BOX 5308 EVERETT IVA 98206 334-�018 <br /> Owner Mailing Address City 2ip Phone <br /> "—�� Mailing Address City Zip Phone <br /> Applicant <br /> DescribeProposedWork single family residence <br /> -- C�Y <br /> ProjedHddress�ifknown) .�ot 3 k23' Intercit � <br /> Atlach four(4)copies of plans lor proposed work- Draw to scale and note the following as applica6le: �Iw <br /> s Property Lines i Centerline of sireet f / ■ <br /> • Oulline and dimensions of all existing and • Indicate North ��� <br /> proposed structures on the lol e Show any proposed qradiny changes <br /> � • Existing and proposed utilities • Show measurements � <br /> r� DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall be made 24 hrs. in advance- phone 259-881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Uesign and Construction <br /> Standards and Specifications. S <br /> 3. Call Location Underground Service 48 hrs before you dig.TOLL FREE NUMBER 1-800•424-5555. �y �� <br /> �s � <br /> 4. Per approved plans signed 12%7/83 and preliminary plat approval 6-79. � • <br /> � �� - <br /> � .D : <br /> � � . <br /> � � ( <br /> �' <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> The i ndersiyned owner/applicant hereby agrees to hold and save harm� - <br /> — — less toe City of Everett Irom any and all claims for damages, costs, - <br /> ' ��c exPenses. or causes ot action ihat may arise because of installation <br /> �— and maintenance of the improvement or other right-of-way use hereto <br /> e,� applied for and turlher ag:ees to remove same upon notice Irom the <br /> �Approved �o s rtion a�e City and to replace public property damaged thereby. <br /> 1 � <br /> _ad`�V�� � ' ,a a.c.� ���,��-a y - <br /> FINAL INSPECT ��� Dale Datc <br /> Approved as Conelructe S gn Wre Applicant <br /> PU9LIC W KS DEPART�dENT WORK THOFI2ED B THIS PERMIT MUST BE STARTEC WI7HIPl _ <br /> evere[t 180 DAYS OF DATE PERM;T IS ISSUED AN� THEREAFTER IS TO • <br /> � 3200 Cedar Sireet BE DILIGENTL�' PURSUED TO COMPLETION. THiS PERPdR L4AY �� <br /> r_vei?It. WA 9ti701 CANCELLED BY THG CITY UPGN AM1'STUP�P;:GL OF WORK ON THI;i <br /> Phoni:: o :.;191 s PRO.!�CT i i!�i-R 9�: f7;�1'S DUi,�4Tl0�1. <br /> !�i <br />