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Date 4-95-94 K 5 Z <br />Application For r <br />PUBLIC WORKS PERMIT <br />O <br />O <br />q U 0 0 <br />Print or Type Only 0 0 <br />TE�� B i �p ? o 0 0 o u4 �' <br />o tri c..9a o <br />Vl tT d- `U .a *ACA <br />SCOTT CHANDLER 5904 LARIMER RD EVERETT Wl%n', 98208 259— <br />Owner <br />Owner _ <br />Applicant <br />Describe Proposed Work . <br />Project Address (if known) <br />Mailing Address <br />L <br />r <br />Mailing Address <br />new house_ <br />Lot 2 Short Plat <br />68-79 <br />i904 Larimer Rd <br />Public Works Permit • <br />169 I / <br />Bldg. Dept• -- A41 <br />RS <br />Public Works Fee $ <br />Total Fee <br />Less Apol. Fee Paid $ _ <br />O 0olr9alance Due <br />o +44N <br />tl+ Id0 <br />City <br />in C'0 fpfOs� �`3 Ouj 4W U <br />J8 J W J N 0 W -'a <br />S <br />ulty <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />rnone <br />PERMIT CONDITIONS <br />I.All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424-5555. <br />W <br />a- <br />Ch <br />W <br />O <br />n <br />q <br />111111111111110 <br />N <br />O <br />✓l � � � � �AWUL <br />uC/St° / <br />ACKNOWLEDGEMENT OF CO DITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of EvJh <br />om any and all claims for damages, costs, <br />expenses, or causeIi that may arise because of installation <br />Z and maintenance opr vement or other right-of-way use hereto <br />applied for and Furtre to remove same upon notice from the <br />City and to replace r erty damaged thereby. <br />PJAL INSPECTIO Date Dale <br />)proved as Constru ed Signature of A ant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />T Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259.8810 PROJECT OVER 90 DAYS DURATION. <br />