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ApplicationFor 3-13-97 � <br /> � PUBLIC WORKS PERMIT Date - <br /> PUBLIC WORKS DEPAfiTMENT Public Works Permit k I � O�` <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-BB10 Building Pertnit# 54505 <br /> T r 1 7 1997 Z�� <br /> IYPE OR PRINT ONLY � +��5!I N U SE�.�'"- Public Works Fee$ <br /> Theo Construction Inc PO Box 2065 Bothell 98041 486-7643 <br /> Owner N� .ling Address City Zip Phone <br /> Owner <br /> AppilcaM Mailing Address City Zip Phone <br /> Describe Proposed Work new house W <br /> � <br /> � <br /> 13�� �ti1a �e. 5� � <br /> PROJECT ADDRESS(if known) M <br /> rrr <br /> Atlach tour(4)copies of plans tor proposed work-Draw to scale and note the tollowing if applicable: O <br /> •Property Lines "Outline and dimensions of all existing and proposed siructures on the�ot •Existing and proposed utilities <br /> •Centerline of street •Indicate North •Show any proposed grading chan9es •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. O <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. H <br /> �', Co►�►ne� iroof �p rv�off -l� 5,•dosew�� V� <br /> .� <n.sfzi!/ ���cc�/tx.�►' (�7`�i�G �✓► `si�s�"i:�+ 000aao9z �x <br /> aon�sos <br /> r.;.o� s�e.� <br /> r�e� s�.00 <br /> lECH f60.Q1� <br /> SRCNtG t�.50 <br /> DRIUII'1 s20.00 <br /> p00009347 <br /> WfiTER l650.00 <br /> q00031064 <br /> SEWER t70.00 <br /> $ySDEV 11296.00 <br /> �o CtIEG: f^c80'c'.00 <br /> ��ci- <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and saee harmle;s <br /> Z7 �7 the City of Everen from any and all claims tor damages,costs,expenses,or <br /> � causes of action that may arise because of installation and maintenance ot <br /> ApprovedforC truc' n' Date theimprovementorotherrigh4of-wayuseheretoappliedforandfurtheragree= <br /> lo remove same upon notice from the City and to replace public property <br /> ��— S �_�7 damagedtt�ere <br /> FI LINSPEC N Date q <br /> ApprovedasConswcted �� � ��S —2�j— I • <br /> g licant Date <br /> Si ature of App' <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHI�180 DAYS OF DATE MIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMFLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UFON ANY STOPPAGE OF WOF�C ON THIS PROJECT OVER 90 DAYS DURATION. <br />