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Q —I 3—28—�{— : <br /> Date �-Z�-92 ( (� f / �uELCWo�ksPermn� ��� <br /> 6U f 0.7�I�U ��- 1 �.� �� 6ioc Oent.. 77441 — ._— <br /> Application Por —�� <br /> PUBLIC WORKS PERMIT °°°.oWF�eFeO :__—. <br /> LossA00��FeePa10 S <br /> � Balance Oue S�� <br /> Print or Type Only <br /> M.J. HANCOCK 9306 1ST AVE SE EVERETT WA 98208 353-4267 <br /> �w�ef Mailing Address � . . ���Y Zip Phone <br /> OWNER <br /> Applicam Mailing Address City Zip Phone <br /> � Describe P�oposed Work NEW HOUSE <br /> Lf. Q� W <br /> Proiec�Address�ifknown) 9210 15T AVE SE �LOT 2) f�Uz� I `� v ' � <br /> Attach four 14)copies ot plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions o1 all existing and • Indica�e North <br /> proposed structures on ihe lot • Show any proposed 9rading changes <br /> • Ezislino and Proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS � <br /> 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be pedormeA in accordance with this permil and current Ciry of Everett Design and Construction <br /> StandarGs end Specitications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. <br /> �� �l�� �,`��'j �i,//cd,�a/�;g-,s �s�'l�Y� �(2t. O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEOGEMENT OF CONDITIONS <br /> � �1 The undersigned ownedapplicaN hereby agrees lo hold anA save hamr <br /> less the City of Everett irom any and all claims for damages. cosls, <br /> expenses, or causes ot action that may arise because ol installation <br /> n ��/I! � —�3 �4-9 C� and maintenance of ihe improvement or otY�r righl�of-way use hereto <br /> V I Y I� applied lor and lurther a9rees lo remove same upon notice Irom the <br /> ���1�'—"''— Dale <br /> Approved I onsiru�tion � Clty and lo replace public propertY damaged thereby. <br /> i� <br /> � �� yf �3 �J „ ., ' - �. .• � ` �- <br /> FI AL N P ✓ W �/ � Date Signat re of Applica t Date <br /> Approved as Constructed '� <br /> WORK AUTHORIZE BY THIS PERMIT MUST BE STARTED WITHIN <br /> �ArI�� PUBUC WORKS DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cetlar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE GITY UPON ANY STOPPAGE OF WORK ON TNIS <br /> Phone:259�8010 PROJECT OVER 90 DAYS DUi7ATION. <br />