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Date 6-29-94 <br />Aoplication For <br />PUBLIC WORKS <br />Print or Type Only <br />John Thom <br />Owner <br />Owner <br />TO!NSTING ut _ H <br />to <br />Ip� INf <br />r S S S O 11� O t f l 8 <br />at tr oo�pps o <br />M 4 M W M M (UJ M M <br />N N <br />PubM1r: wetka Permit . -!ft4/ .7 <br />Bldg. Debi.44781 <br />Pubs¢ Works Fee S <br />Total Fee <br />Less A0e1. Fee Pad S <br />uc S 7-<!, <br />17 Rockefeller Ave Everett 98203 348 r�778 ~ <br />i\93.Address C—T"` A Phone <br />oS2=b'fis zc ri 1W <br />Applicant M3ihrlg Address <br />Describe Proposed Work -new house <br />Project Address (it known) �S(r-- <br />Attach four (4) copies of plans lot proposed work - Draw to scale and note the :o8owmg 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 • Shuw measurements <br />DO NOT WRITE BELOW THIS LINE <br />Phone <br />PERMIT CONDITIO14S <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. <br />Approved for Cotistructspri Dale <br />FINAL INSPE TION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />rF Everett. WA 98201 <br />Phone: 259-8810 <br />W <br />Ch <br />Im <br />O <br />n <br />z <br />O <br />O <br />a <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 />apphed for and further agrees to remove same upon notice Item the <br />Cdy and to replace public property damaged thereby. <br />,Zignature of Applicant Datb <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />