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� � <br /> y, a� <br /> ppplicaiicn For Date _ _6 10 9�_ __ l <br /> � PUBLIC WC)RKS PERMIT publicWorksPermitk _�Iq�183 _ � <br /> PUBLIC WORKS DEPARTMENT � <br /> 3200 Cedar Street � <br /> Everett, WA 9C201 (425)257-8810 Building Permil N B62716 <br /> TYPE OR PRINT ONLY fAN ? 4 Z(� Public Works Fee$ ��h J _ � <br /> TC POSTING _--- <br /> KOOII SEFF 'i!3 E DA !IC.i LOOP RD LK STEVENS 98258 425-343-5939 <br /> Owner Mailing Address City Zip Phone <br /> Applicant Mailing Address Ciry Zip Phone 9 <br /> 1 <br /> Describe Proposed Work _ NEW HOUSE •- BASIC ?.048 � � <br /> � � <br /> -- �� <br /> V/ <br /> } <br /> � `',� M � <br /> PROJECT ADDRESS (if known) �4 � I ✓1'l✓�G�i L 2 - W � <br /> Atlach lour(4)copies plans br proposed work-Draw to scale and note the tollowing if applicable: � 1 <br /> •Property Lines •Outlina and dimensions ol all existing antl proposed siructures on the lot •Existing and proposed utilities f <br /> •Cenledine o�street •Indicate North •Show any proposed orading chacges •Show measuremenls � � <br /> DO NCT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Q <br /> 1. All calls for inspection shall be made 24 hours in advance- phone (425j 257-8810 <br /> 2. All work shall be performed in accordance wilh this permit and current Ciry of Everett Design and � <br /> Constru�tion Standards and Specifications. , i <br /> 3. Cali Loration Underrround Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800-424-5555. ♦/t, <br /> Vi <br /> "T � Tiql�-�� in� d�'7n��ns�c�,Q -�'r� rta�-� G�owh5��5 �o c�r7t,l� 5'{��t�J � ! <br /> �J � ; <br /> 3 <br /> 50. � <br /> 4 <br /> ^C <br /> � <br /> 3�;. <br /> ;c;, i <br /> <<, � <br /> ��Z�''� <br /> ' ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agrees to hold and save harmless � <br /> the Ciry of Everett irom any and all claims for damages,cosls,expenses,or <br /> r ie or ons ruc ion a causes of aclion that may anse because of installati�n and maintenancr.of the <br /> PP � improv ?nt or o er nyh f-way use hereto applied for and further agrees ro <br /> ;/ `� � '- �-. rem e sa e upo no;ic f om he City and to replace public properry dam- � <br /> /�./�� �[ 'UJ'L[.-�. l/-.Z - f 7 ag there . � / I <br /> FiNALI�'SPtCTION Date � 2'� `�{, � <br /> Approvetl as Cons�mct2d <br /> igna o n ` \ a ( <br /> NARKAUT}iORIZED BYIHIS PERMR MUST BE STAHfEC'MTHIN 180 DAYS QF DATE PER IT�S ISSUEDANDlNEREF"r"IER IS TO BE DIUGEMLY PURSUED TD <br /> COMPLE!lON.7N�S PERMR MAY DE CANCFLLED BY THE CfTY UPON A�JY STOPPAGE OF WQFiK ON 7HIS PFiQECT OVER 5J DAYS WRATION. <br />