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•i <br /> �� <br /> P" <br /> Date 11/15/8 3 Pu�lic Works Parmil, '� � <br /> em9.000�.• 83/12 91 <br /> Application For <br /> PU�LIC WORKS PERMIT PUOTa11FeeFee S �, _ <br /> Less Aoo�.Fce Pa�a g��/� - <br /> Balarce�ux $ '^�� <br /> Print or Type Only � �J �g� <br /> / <br /> DUJARDIN_^r'."'LC.^R�ENT PO Box 5308 _ EVARF.TT lVA 98206 334- 50�8 <br /> Ovmcr � Mailing Atldress Ciry Zip Phone <br /> S Applicant Mailing Address Ciry 2ip Phone <br /> DescribeProposedWork S�ng1E �amlly residence <br /> � <br /> ProjectFddress(itknown) Lot 1 �I Intereity � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the tollowing as applicable� � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and � Indicate North <br /> proaosed siruclures on the lot • Show any proposed gradiny changes <br /> • Exisling and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS I.INE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259-881 5. � <br /> 2. All work shall be performed in accordance with this permit ard current Ciry of Everett Design and Consiruction <br /> Standards and Specifications. I � <br /> 3. Call Location Unclerground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. <br /> 4. Per approved plans signed 12/7/83 and preliminary plat approval 6-79. O <br /> � <br /> �I/ <br /> O <br /> a <br />! ACKNOWLEDGEMENT OF CONDlTIONS <br /> The undeisigned ownedapplicant hereby agrees to hold and save harm- <br /> less the City of Everetl from any and all claims for damages, costs, <br /> �/ ��xpen,es, or causes of action lhat may arise because of installation <br /> � l and maintenance of the improvemeN or other right-of-way use hereto <br /> `-- /�—� applied lor and luriher a9rees lu remove same upon nolice Irom the <br /> Approved f r .pn tr ion a�e City and to replace public property damaged thr.reby. <br /> / <br /> � <br /> � ���1� ��" ,� � �-a6-� <br /> FINAL INSPECTION � Date Date <br /> Approved as Conslructed� S g a� re of licanl <br /> �� WORK AUT FIZED BY TH S PERMIT MUST BE STAH�'�D 1NITHIN <br /> everett PUBLIC WORr: DEPARTM NT �g0 DAYS OF �P,Tt PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet pE DILIGENTIV PUFSUED TO COMPLETION. THIS PERMIT MA'I BE <br /> Everelt,WA 98201 CAtJCELLED BY THE CITY UPON ANY STOPPl,GE OF WORK ON THIS <br /> Phone: 259-8815 pROJECT OVER 90 DAYS DURFlTION. <br /> I � <br />