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TYPE OR PRINT ONLY <br />AppNceaon For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257.8810 <br />0 POSTING LxT'_ 219A Publlc4ftftcalye$ <br />ri r-i <br />Date 4112/99 <br />Public Works Permit N <br />Building Permit N <br />Owner Mailing Address city., Zip Phone <br />r, <br />CONTACT: JOE DAWSON 425-334-0935 a <br />Applicant Mailing Address city! a _,.. _: Zip „ !' Phone <br />Describe Proposed Work NEW HOUSE W <br />to <br />) <br />,�ffM <br />PROJECT ADDRESS (if known) '46 i/�/ HAuan W <br />Attach four (4) copies plans for proposed work • Draw to scale and rate the following if applicable: O <br />• Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities MOD <br />• Centeriine of street • Indicate North • Show any proposed grading changes • Show measurements <br />DO NOT WRITE BELOW THIS LINE Z <br />PERMIT CONDITIONS: O <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. . <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. /A <br />4. All �U dra016kc sin Il Lae tT7ttl�oed � otxUc dYn►�na1a 0 <br />4VWX 2+t �Vtt b�pGfiwu+ 04 flu ti A 16c,k Nd kou u . a <br />5. It -Afffors-Ih*UAr-sIde scwu-far-tom's ilil Ncad+bo Ise <br />ejmF d. I" thAl, evr44, -,m prwte wmm hole ML44c 60 sat an V+T s lot <br />ha2r �^t k Q e' Ne. T', hovseb P� 611S+4m stiw11 disclster 400 4JAe <br />rylikk kil . 1-v-ort, -Nu wfat-I hole A side SeL r r Its f4*- ci{Lj std <br />alb *&01 4M 3h�eN ba cv4wJte�,`D �+e`pibIreWWIV1. <br />(o, lnybul ems;p„ can-rol A da�nH;ll sldeo(- constru�e <br />ction 'tt:iLS -60 sbtr3:Iny <br />(fin 5k�'vc�tO✓t <br />-7, pot,Keru wr-115 1•1 CXCOS off' 8' ha ht ,Ire s&t»Ip of- strucbi si,I W. del Cavan ie <br />a uuA S ;n ca 6%1 0+ 4r hG it: .i,yc �i�dlhg Pef►'tft An" *rwi;"rXI ray"'ew. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />harmless�n The undersigned owner/applicant hereby agrees to hold and save harmless <br />1 / 1 5/7 12C' the Cityof Everett from any and all claims for damages, cosh, expenses, or <br />V4)prcvdd for rpnst Uale causes of action that may arise because of Installation rd rnYnMnance of the <br />/ improvement or other right-of-way use hereto applied for and further agrees to <br />remove sa otke from the City and to roplace pudic property dam - <br />FINAL INSPECTION Date aj — c <br />ADDroved as Constructed l - <br />WORN( AUMRIZED BY THIS PERMIT MUST BE STARTED WFI HIN 180 DAKOF IS ISSUED MO THEREAFTER IS TO BE DLKiENMY PUR911®1O <br />COMPLETION. THIS PEFINI T MAY BE CANCELLED BY THE CITY # Y UPON ANY OF WOW ON THIS PRaECTOVER 90 DAYS DURATION. <br />