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Date 1z�16/94 <br />Applicalion For <br />PUBLIC WORKS <br />Print or Type Only <br />Lv— 1� k PO <br />Owner <br />� <br />Describe Proposed Work _ <br />prolect Address (if knownl — <br />'I-132� <br />i; <br />PE�iMIT <br />T��., r ��TING � <br />�' f_, O f �[.'� p r� <br />�. lr� Gi r� �°. n� r_� <br />�--. .�Y 19� p f.] �[h fJ <br />�a .,� v� r i <br />c� �r ��� .,_ � <br />ciry � <br />i [`) '1 ['� — <br />u � r. i , . <br />" ` i ��� ..i ��, r.� <br />(i�� ii.. Y .� .` t i <br />Publ¢ Wo�hs Permn • �� <br />Biag. Deo�- • � �� 9 � <br />Pubi¢woeksFea S <br />(� Tolal Feo <br />�`%I �1 Less POGI. Fee Paid 5 <br />� ��� 5 <br />G �-� �- �BelanceDue <br />p fn r_ <br />cr�u��' <br />-'' <br />:��P�� _ Phone <br />r'� <br />c�„i �. <br />i,� - <br />n; r: � � _I i.J -- <br />At�ach four (5) copies of plans for proposed work � Draw lo scale and note.� Cenllerline ol stpee� able: <br />• Property Lines • Indicate Norlh <br />• Outline and dimensions of all existing and � Show any proposed grading changes <br />proposed strucW res on the lot � Show measuremenis <br />• Existin9 and pwposed utilities <br />..., .�nr �n�oirF RFi OW THIS UNE <br />Lot 4, SP 23-94 <br />��,• <br />�O��W�Q. PERMITCONDITIONS <br />`� 1. All calls tor inspection shall be made 24 hrs. in advance- phone 259-SB � <br />!� 2. All work shall be pertormed in acwrdance with this permit and current City of Everetl Design and Conslruction <br />�\\� Standards and Specifications. <br />r� 3. Call Locatien Underground Service 48 hrs before you dig TOLL FREE NUMBER 1•800•424•5555. <br />t udvc�ttin ttie�suee� (uray lrzqui�z i�stalintion�of s�new entcli basii ) e Clous� ��wit i,the PuLlicrWorks <br />uup�cter prior to coiwcctiou - Vliunc 339='t0a. <br />S fhe residence 6uilt on this Int i� required to install a tire sprinkler rystem meeting NI�PA 13D. <br />qpproved asc <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Streel <br />Everett, WA 98207 <br />Phane:259�8810 <br />Date <br />Z <br />� <br />rf^ <br />V♦ <br />O <br />a <br />ACKNOW�EDGEMENT OF GONDITIO�!5 <br />The undersigned owner/applicant hereby agrees to hold and save ha,n- <br />less Ihe City ot Everetl (rom any and all claims for damages, r.osts. <br />eapenses. or causes ol action that may arise because ot installation <br />and ma�nlenance o1 lhe improvemen� or olher right�ohway use herclo <br />applied for a� furiher a9rees lo remove same upon notice Irom the <br />r�,✓SAd tnleoiAce p�bllc properiy damaged Ihereby. <br />� <br />S� <br />g re o1 ApP��cani <br />y� K AUTHORIZED BY TWS PERMIT MUST BE S7ARTED WITHIN <br />� DAYS OF DF�TE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DVLIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />PROJECT OVER 90 DAYS DURATIpN.STOPPAGE OF WORK CN THIS <br />