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I 1 <br /> ;\ � � <br /> � ApplicationFor Da�e 6/10/99 i <br /> �iw�� PUBLIC WORKS PERMIT / � <br /> Pub"c Works Permit q '� <br /> �C� PUBLIC WORKS DEPARTMENT <br /> 3200 Cedar Street <br /> Everett,WA 98201 (425)257-8810 Building Permit N B62717 _ � <br /> I <br /> i <br /> TYPE OR PRINT ONLY 'ublic Works Fee$ � � <br /> KOON JEFF 513 E DAVIES LOOP RD LK STEVENS 98258 425-34 939 <br /> Owner Mailing Address Ciry ::ip Phone � <br /> Applicant MailingAddress City 7.ip Pho�ie <br /> Describe Proposed Work NEW HOUSE — BASIC 2048 W <br /> � <br /> --- ♦ofl= <br /> V+ <br /> PROJECT ADDRESS (if known) �Z � I n'�►'G LOT 3 SIIOF.T PI,nT 44-97 W <br /> � <br /> Attach tour(4)copies plans lor proposed work-Dravr to scale and note e lollowing if applicable: � <br /> •Property Lines •Oulli^e and diroansions of all ezi::ting and prop sed stmctures on the lot •Existing and proposed utilities <br /> •Centedine of sireet •Indicate NcAh •Show any proposed gr ing changes •Show measurements � <br /> DO N T WRITE BELOW THIS LINE <br /> PEfiMiT CONDITIONS: o <br /> 1. All calls (or inspection shall be made 24 h rs in adva��ce- phone (425) 257-8810 <br /> 2. All work shall be performed in accordanc with this perrnit and current ' of rverett Design and � <br /> Construction Slandards and Specificati s.. � <br /> 3. Call Location Underground Service 4 hrs. before you diy. TOLL FREE NUMB 1-800-424-5555. ♦/11 <br /> � Vy <br /> �� �ql�-� I�ne dr-7� c�,C -�om �y��� -�s �,l-, 5��. 0. <br /> J r�� <br /> ( � <br /> _ui'ic, ;,._ <br /> `:S:CH f•�;. <br /> CHu <br /> ,V� <br /> cc <br /> y�.y�� � <br /> t�." �� <br /> ACKNOWLEDGC-MENT OF CONDITIONS <br /> ,^ �_/� The undersigned owner/applicant hereby agrees to hold and snve harmless <br /> /n� Uie Ciry of Everett from any and all claims br damages,costs,expenses,or <br /> � causes ot action thal may anse 6ocause ol installatiun and maintenance of the <br /> pp;ov r ons mc ion improve�ment or other righ4ol-way use hereto applied for and tuf,her 2grees to <br /> , c �/�C��,,� � S._�o remove e upo n ice irom the Ciry and to replace public pmpert,7am• <br /> 8 � 1 � �1/ � aged t ereb <br /> FINAL INSPECTION Date � �> 4,ti <br /> Approved as Constructed <br /> ignat�r p ic � e <br /> WORKAUT110RIZEDBYTHISPERMRMUSTBESTARTEDWITHIN780DAYSOFDAiEPE MRISISSUEDANDiHEREAFZERIST08'cCIIJGEMLYPURSUEDTO <br /> COMPLETION.hIIS PEPSAR RMY EE CANCELLED CiYTHE CffY UPON ANY STOPPAGE WORK ON 7}iIS PRQIECTOVER 90 DAYS DURATION. <br />