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Application For 3-14-96 <br />PUBLIC WORKS PERMIT Date PUBLIC WORKS DEPARTMENT Public Works Permit # (2%l��j� <br />am C- <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 Building Permit # 51724 <br />;17. - <br />�,.,, - - -- 1Public Works Fee $ � <br />TYPE OR PRINT ONLY <br />LOUTSIS HOMES INC 4618 127TH PL SE EVERETT 98208 338-4247 <br />Owner Mailing Address City Zip Phone <br />OWNER Phone <br />Applicant Mailing Address City Zip <br />Describe Proposed Work NEW HOUSE ILU <br />LE <br />PROJECT ADDRESS (if known) errand _�VCJ M <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: O <br />•Property Lines `Outline and dimensions of all existing and proposed :nn ctures on the lot 'Existing and proposed utilities <br />`Centerline of street `Indicate North `Show any proposed grading changes 'Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. 06/12/96 12:30PM 001 <br />3. Call Location Underground Service 48 his. before you dig. TOLL FREE NUMBER 1)IM-424-5555. <br />4. di/jjlgcf t v✓rS�u✓r3 Src�PSP�../G' <br />5- fiei v4e dlr-f1 ACC-1 1 fir"' 1 <br />; r7 <br />SPA✓ aS�o✓ 5-fj f1r%�.� <br />41 <br />Approved for Co rucf Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />#00051724 <br />BLDG $416.72 <br />PLBO $63.00 <br />ea <br />"Y4.S� <br />DRIVkV $20.00 <br />#00008971 <br />ATER $109.00 <br />e (�Cl <br />k00030669 <br />SEWER s70.50 <br />SVSDEV $1296.00 <br />CHECK. $2065.ca <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages. costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHOIZED BY THIS COMPLETION.RTHIS PERMIT MAY RBE CANCELLED BY THE CITYIUPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAAYS DURATION. <br />PURSUED TO <br />