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Date ��19�86 <br />ApFlication For <br />PUBLIC V!�'�RKS PERMIT <br />Print or TyFe Only <br />PUE11t Worhe Permlt • `-' �—� iC <br />eieo. oem.. 66/16068 <br />PUEIm Wo�ks Fee <br />Ta�w� Fea a _ <br />�ese eoo� Fee Wam S ,�__ <br />Belence Dur S �- <br />Metco �';onstruction 17018 15th N.E. Seattle 98155 363-0316 <br />Owner Mailing AdAress Ci�y Zip Plione <br />Same <br />Describe Proposed Work <br />Project Address �if known) <br />Mailing Address <br />Construct Sin gle Family Residence <br />- � � ��,�� <br />ZiP Phone <br />Attach four (4) copies of plans for proposed work • Draw to scale and note �he lollowing as applicable: <br />• Property Lines • Centeiline ol street <br />f�' • Ou�line and dimensions ol all ezisling and • Indicate I��lorth <br />proposed structures on ihe lot • Show any �roposed grading changes <br />• Exisling ard proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•$8� 5. <br />2. All work shall be perlormed in accordance with this permit and current City ol Everett Design and Conslruction <br />Standards and Specilications. <br />3. Call Locaticn UnAerqround Service 4B hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />y <br />5 <br />b <br />%icR., cQ.w�-r�L�u,,.,,T.,_ rc.+�,- .�c•-cn,� a-/,zr,i.�..,� �-,-i <br />�.��'�d�e,�,�x.GGt, c.�,�--��(— w�.c.�� �ca�.,� ��1,,,'f- �c��,-i <br />��-`� .�s✓� i].rr an� iJr-o'f- ,Go-- ,.�,�.y�,s.�,i- -�2�, <br />�. <br />� �o�l.�. �-o�� <br />Approved for Gons ruction Date <br />i <br />y�.✓cc-� 7�Z 3�4c• <br />FINAL INSPECTION Date <br />ApprovuA as Construcled <br />everett H� �dLIC WORKS DEPARTMENT <br />3200 Cedar S�reel <br />Fverett, WA 982C1 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />�"' <br />� <br />� <br />0 <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less Ihe City ot Everett irom any and all clai;ns lo� damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance ot the improvemenl or other righ4of-way use hereto <br />applied lor and further a�rees b remove same upon nolice irom the <br />City and to ieplace public ��roperty damaged ihereby. <br />s - <br />v/ ' l / <br />Sic�nature ol Applicant / / y�e <br />WORK AUTHORIZED BY TliIS PEHMIT MUST BE STARTE WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEfi IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAfiE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUR.4TION. <br />