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Date 4-1-94 <br />PUBLIC <br />Print or Type Only <br />Andrew <br />Owner <br />Owner <br />Applicant <br />Describe Proposed Work _ <br />Project Address (if known) _ <br />�r"�— -w <br />� � � _ � � � 1 <br />Application Fo� �- 3G Zq-Q- <br />WORK��E �I�(� ' <br />�p TO -PO�T�N �z-Za-Ys <br />b <br />a u�ig�g <br />� I� � uu�i <br />ti M. <br />Mailing <br />Mailing <br />new house <br />Lot 2 Short Plat 1 <br />v�iga c�i��p�. <br />.t ON 00�+ <br />«M � ��.�t <br />w .-+ <br />c=.� ��gi a � „ <br />on�',�o�'i�xo W i rw <br />8i r'�i = 7.ti m o a� m.'�-� � <br />Attach tour (4) copies of plans for proposed work • Draw to scale and note ihe following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed siructures on the lot <br />• Existing and proposed utilities <br />Approved for <br />% <br />PuEiic Warka Permit ♦ <br />eiaa� oeai.. 439 5 <br />Pu�l¢ Works Fee <br />7ote1 Fee S <br />�Bsa AOP� Fae Peitl S �/ <br />BalanceDue S (pr� <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. AII calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shali be performed in accordance with this permit and wrrent City of Everett Design and Constructlon <br />Standards and Specifications. <br />3. Cal� Locetion Underground Service 4B hrs. before you dig. TOLL FREE NUMBEN 1-800-424•5555. <br />�� C.P7Y1Y�2CEi ,�p��S VCz_. <br />�b v i ded -tn I o� . <br />FINAL INSPECTION <br />Approved as Constructed <br />�A��PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Evere@, WA 98201 <br />Phone:259-8810 <br />-(-� 5larm d rA.1►� s1�-b <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />� <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City of Everett Irom any and all claims lor damages, cosis, <br />ezpenses, or causes of action that may arise because of installation <br />��mam 9f �-i�ipro�ement or other righPot-way use hereto <br />applied ip . urt agrees �tc remove same upon otic trom Ihe <br />\ty ai r lace Iic pro erty damaged thereby. <br />.5 3 1 � <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAFiTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TH�S PERMIT MAY BE <br />CANCELLED Bl' THE CITY UPON ANY STOPPAGE OF WORK ON THIB <br />PFOJECTOVEF 90 DAYS DURATION. <br />