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Date2�14/66 <br />Application For <br />PUSLIC WORKS PERMIT <br />Print or Type Only <br />Metco Construction 17018 15th N.E. Seattle <br />Owner Mailing Address City <br />Same <br />Applicant Mailing Address City <br />Construct Single Family Residence <br />Describe Proposed Work <br />Project Address (if known) <br />� �'., o,�. s <br />PuOucWorkePermll• B(O—�P�]` <br />emy. oaoi. • E6/16072 <br />Puefc worka Poa s <br />Totel Feo <br />Leaa ApO� Fee Paitl S—�_ <br />Balmce Due S _ _ Q�' <br />83 9 9 <br />98155 363-0316 <br />ZiP Phone <br />ZiP Phone <br />Attach lour (4) copies of plans lor proposed work • Draw to sca�e and note Ihe following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lol • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERIAfi CONDITIONS <br />1. All call� lor i�ispn.��ion shall be made 24 hrs. in advance - phone 259-8F3i 5. <br />2. All worY, shall be periormed in accordance with this permit and current Ci�y of Everetl Design and Construction <br />Slandards and Specilications. <br />3. Call Localion Underaround Service 48 hrs. before you diy. TOLL FREE NUM6ER 1-800-424•5555. <br />I, Tu- ddUi✓� q�.�� i�` � C.�/LF,..w <br />5, s/� j c'"'� �' �l �,ti2w'f uM%w/z¢n , <br />�. °��..e (,u�s s� �.o �-f- -1,> u-..-�.-..-�- s,.� G�,-� <br />Approved lor <br />FINALINSPECttON � -1 \ � <br />Approved as Constructed V <br />everet� PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259-�815 <br />Date <br />W <br />. <br />� <br />N <br />� <br />O <br />�"' <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less ihe City of Everett Irom any and all claims br damages, cosis, <br />expenses, or causes of action ihat may arise because ol installation <br />and maintenance of Ihe improvement or other right�of�way use hereto <br />applied lor an 'lurther agrees to remove same uoon notice Irom the <br />City and to r lace public p�erty damaged thereoy. / <br />�c,yfature of Ap�licant /" " Da(e <br />WORK AUTHORI2ED BY THIS PERMIT MUST E�E STARTED WITHIN <br />780 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE Dll IGENILY PURSUED TO COMPLETION. T�IS PERMIT MAY BE <br />CANC�LLED BY THE CRY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />