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� <br /> ApPlicatlon For M / <br /> � PUBLIC WURKS PERMIT Date_ �7-97 <br /> M <br /> PUBLIC WORKS�EPARTMENT Public Nbrks P�it M 2 ' <br /> 320o Cedar Street ;;� <br /> Everetl.WA 98201 25y;8A10�N1s Building Pertnit 5563a <br /> POSTING''-'�', " "" <br /> TYPE OR PRINT ONLY �� p pp uglic pWodks Fee S� <br /> �M 0`i00S Ifltl �ry00 O M 47 <br /> Pavel Gudev 1'.h15 Hwy 99 IIB204 Evera��r"i��� ��r���`i-i" r�i m "-_' <br /> Owner Mailing Address City Zip "'� M M ¢ Phone <br /> OWllei -� � � <br /> Applicant Mailing Address �U C 9 � � � � � � o o phone <br /> oamn'J. � u�i � au� Sm � <br /> Describe Proposed Work new house � <br /> � <br /> � <br /> �// <br /> PROJECT ADDRESS(if known) 10409 3rd Ave SE Lot 2 SP 1118-94 � <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note lhe following if applicable: O <br /> •Property Lies 'Outline and dimensiure of all existing and proposed slructures on the lot •Fxisting and proposed utilities <br /> •Centedine of strect •Indicate Norlh •Show any pmposed 9rading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> I' ''MIT CONUITIONS: Z <br /> 1. ,,II calls for inspection shall be made 24 hours in advance- phc,��e 259-8810. O <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design ar�d <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. befoie you dig. TOLL FREE NUMBER 1-860-424-5555. � <br /> 4i, 1 ��d;u;c�vZ, ) �i�� (���i� o✓� wa�W s�vi C,� � �:1�� S � <br /> ���s� . �� O <br /> 5. P���;d� 4 p�-� s-{�-�� C�;�e�.-�E,) �,r K� 54_ -� t�� � a <br /> � � ACKNOWLEDGEMENTOFCONDIT10N5 <br /> Irp , --7 /^ ��� The undersigned ownedspplicant hereby agmes to hold and save hartnless <br /> ( `� the City of Everett f.rom any and all claims for damages,costs,�ezpenses,or <br /> - wuses of action that may arise because of installation and malntenance of <br /> Appr v orConstruction Dae }heimprovementorotherright-of-wayuseheretoappliedtorandfurtheragiees <br /> �� /�'1 to remove same upon notice fmm the City and to repla:e public property <br /> ��• t� .!/� � /_���7 sQ damagedthereby. <br /> f1"/lY Ll /— O <br /> FINAL INSPECTION Date �� r . <br /> Approved as Constructed �' � <br /> l p:� / <br /> Signature of plicant �� Dato <br /> WORK AUTHORIZED BY THIS PERMI7�MUST Bt STARTED WITHIN 180 DAYS CIF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DIUGEN7LY PUIiSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE Of WORK CN 7NIS PROJECT OVER 90 DAYS WRATION. <br />