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Date j r21-95 `. / //5t /.,DOA Public Works Permit# <br /> 3453 <br /> Application For V/V/ K.� / Bldg.Dept.* <br /> 49024 <br /> vss <br /> PUBLIC WORKS PERMITS Public Works Fee $ <br /> i Total Fee <br /> • <br /> 8 Less Appl.Fee Paid $ <br /> 204,9 <br /> Print or Type Only a t <br /> Balance Due $ <br /> i 4 <br /> Bruce Overstreet 605 Maulsby Lane Everett 9 01 25 8282 63ra n <br /> Owner Mailing Address p. `C g i dip PhAe,J <br /> Owner g 5'ad 5i <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work retaining wall = = - ", ) <br /> W <br /> Project Address(if known) 605 Maulsby Lane <br /> Imm <br /> Attach four(4)copies of plans for proposed work Draw to scale and note the following as applicable: <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS 0 <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. z <br /> C�1 , s' S7eG- e9.1 ez* 4 s� 41 L -fimeS 0 <br /> I- <br /> Cl) <br /> 0 <br /> AMMIMMOMMEM <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm <br /> less the City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance of the improvement or other right-of-way use hereto <br /> - applied for and furthe ees to remove same on notice from-the <br /> Appr or Constru on Date Ci o replace b is roperty da ged th r y. <br /> FINAL INSPECTION Date <br /> Approved as Constructed S 21144°J' <br /> of Applican Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: PROJECT OVER 90 DAYS DURATION. <br />