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Date�;�93 I� fI1J1�11G_2�� — � <br /> � J -Zv - � �j <br /> -� PUUbc WorMa Parmil r -i .J ���L_ <br /> Application For � Bltlq.pepl.• 40212 <br /> PUBLIC WORK� RERMIT <br /> PubL<Worxs Fee <br /> UTolal Fea $��— <br /> Pri nt or T � �ess/opL Fee Pma 3 T�,�7 _ <br /> ype Only � �,�, f^,, Q o �o � g op � � 4Baiance0ue i $��� / <br /> ' � � � G � � � ociom <br /> '� � A CJ �ii (., <br /> Ln;cecrest Construction 4641 Silve:�tip Lane F.ve�ett�WA w982[Si 259-6005 <br /> Owner h��i 1 (�✓; I,b(� Mailing Addre� �. .. <br /> S � �� � s �,3 q 41 � � �.�,_ Phone . <br /> Owner o `J� o� W �' f',T � � �- � '" � c� <br /> J Wa�.. r =w <br /> � `— 0] G, T_ 45 N Ll ]t � :S (n n] .r i� <br /> Applicant Mailing Address <br /> City Zip Phone <br /> Deocribe Proposed Work neW house <br /> Project Address(if known) �`�W� J un����,� u�� Lot 11 � ! <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the lollowiny as appiicable: H <br /> • Property Lines • Centerline of sireet — <br /> • Outline and dimensions of all existing and � <br /> proposed structures on the lol • Indicate North <br /> • Existing and proposed utilities � Show any proposed grading changes <br /> • Show meas�uemenis <br /> DO NOT WqITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•$$�p, <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Consiruction � <br /> Standards�nd Specifir.ations. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. <br /> q, Co-ord�natc ��i�t�, t�ic Publ;� ��rorKs lne�c�-to�� �335 �740�-� ,Z <br /> �v��l-i �-Gyard -f.v ��I�eenieH�. o �{ ���e ��-,d �(, �„�c+ -Llic �I,-a,���y� O <br /> � � <br /> G���GI� �'GYGSS k�h� •, �r2�p8���•t� y✓�n��q� . <br /> � �! � <br /> V♦ <br /> O <br /> a <br /> !-"�.� .'%f� . ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneryapplicanl hereby agrees to holtl and save harm- <br /> ' '. 1 / less Ihe Clly ol Everetl irom any and all claims lor damages. costs, <br /> J t.-�/_ � eapenses, or causes ol ac�ion ihat ma arise because of installation <br /> � IL�' � � /�/y� and maintenance ol !he improvement or o�her righl�oFway use hereto <br /> App o�d lor Constructioq— apP��ed for and furlher agrees to remove same upon notice Irom �he <br /> /� !.<� % -.— � � a�e City and to replace public property damageJ th=reb <br /> � : /'<,,t`1_ / / -_�,� <br /> , , <br /> ,:_,..��`� :� r .-', _, „ ) 1 <br /> FINAL INSPECTION - � �� ' <�'^/ <br /> Approved as Consiructed � a�e � . �i '/.," —�--�� <br /> ��'� S 9`�at,y�e of Applicar}t� Date <br /> PUBLICWORKSDEPARTMENT W�A� AUTHORI �D�B THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF �7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WAg8201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />