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� � � <br /> H � <br /> 4" F'� • <br /> 9HCn <br /> Ko� � Date_3�1242 " ��°JZ'"`�•'4 v���,�wo,w,; ,��. 92 II , <br /> �+tl y�il Application For oiae�oeo�.+ +658 <br /> yPubl¢Wo�ke Fe� <br /> � x PIJBLIC \IV4RKS PERMIT TolalFeo 5_ <br /> �f � � T(}, PQSTING �essRDPIFeaPaiCS_ <br /> OH ' <br /> F/�+ � g Print or Type Only 3J �3 a�ance Duc s��o— <br /> Y�Y C] <br /> yH <br /> t" y� Duke Snyder PO Box 1188 Mukilteo 98275 348-9047 <br /> �y Owner Mailin9 AdJress � City Lp Phone <br /> � t� �n+ _ -- <br /> Leghorn Enterprises PO Box 1183 Mukilteo 98275 745-3577 <br /> �y y Applicant Mailing Address City Zip Phone <br /> HOCn <br /> Describe Proposed Work new SFR <br /> W <br /> ?roiect Address lil known� 4829 Gienwood Ave. � <br /> Attach lour(4)copies of plans lor proposed work• Draw�o scale and nole�he following as applicable� � <br /> • Property Lines • Centerline ol sireet /^ <br /> • Outlirie anci rfimensions ol all ezisting and • Indica�e Norih V� <br /> proposed slructures on the lot • Show any proposed gradin9 C�anges <br /> • Existing antl proposed utilities • Show measurements �A <br /> � DO NOT WRITt BELOW THIS LINE O I <br /> I I PERMIT CONLi fIONS � <br /> 1.All cells for inspection shall be made 24 hrs.in edvance-phone 259•8810. <br /> t�' 2.All work shall be pedormed in acccrdance wi�h this permil and current Ci�y of Everelt Deslgn antl Consiruction � <br /> '�t Standards and Specilications. <br /> 3.Call location Undergrcund Service 4B hrs.belore you dig.TOLL FREE NUMBER 1•800-424-5555. w <br /> '_' /1 f <br /> , —l . po�YM SPov�S -� '}'�^2✓� L�l G�r�.IVIS , O <br /> / � <br /> � � <br /> �' � <br /> �-� a <br /> ' ' ACKNOWLEDGEMENT OF CONOITIO�S <br /> 1 ��� The unAersi9ned owner/applicant hereUy agrees to hold and save harm- � <br /> ' ' less ihe Cily ol Everetl Irom any and all claims lor tlamages, costs. , <br /> n � C exFenses, or causes ol action thal may arise because ot installation <br /> ��_ /1 _ �...Q antl maintenance ol Ihe improvement or other righPol-way use hereto <br /> i_�, _� � applied �or and lurther agrees lo remove same upon nolice Ircm ihc �i <br /> Approved lor Construction Date Cily a to r place publi ro rty dama ed th hy. �, <br /> ���� .3-/-l3 � �/��� I . <br /> FINAL INSPECTION Date � <br /> Approved as Const�ucted Si alure ol Appli � Date <br /> �_� PUBLIC WORKS DEPARTMENT WORK AUTHOR Z BY THI PERMIT MUST BE STARTED INITHIN <br /> ,—�' .'.200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> w BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> �� Evoratt.WA 98201 CANCLLLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonc:259�8810 PROJECT OVER 90 DAYS �JFATION. � <br /> —___'_"'._ _. . I <br />