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Date 2/a/�5 I PUCI¢NbrA�Permit• G�����` <br /> eiea.oao�-. 85/14441 _ <br /> Application For <br /> P'�BLIC WORKS PER11�iIT Pu,lo�FeaFea s <br /> �ese nooi Fee va�o S_ <br /> oaie��a o�� s �(. .DC <br /> Print or Type Only �ffb,Ls <br /> Wm. S. Janes 724 Tulalip Road N.E. Marysville 98270 653-1324 �� <br /> Owner Mailinq Address City Zip Phone <br /> Same <br /> Applicant MadingAddress C�ty ZIP Phone <br /> Describe ProPos�d Work Construct Single Family Residence _ <br /> - _ W <br /> ProjectAddress�ilknownl ����/J T�F��`�� v� �'��' — � <br /> Attach lour(4)copies ol plans lor proposed N�ork- Oraw to scale and note thr, tollowinq as apphcable: � <br /> • Property Lines • Cente�line of slreet �A <br /> • Outline and dinensions of all ezi:�ting and • Indicate Norih V� <br /> proposed siructures on Ihe lot • Show any proposed grading changes <br /> � Eaisting and proposed utilities • Show measurements � <br /> DO NOT WRITE DELOW THIS L�NE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance with ihis permit and current Ciry oi Everett Design and Construclion <br /> Standards and Specifications. <br /> 3. Call Locaticn Underground Servir.e��9 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> �w <br /> _/ <br /> O <br /> a <br /> ACKNOINLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> -- less Ihe City ol EvereU Irom any and all claims for tlamages, costs, <br /> / expenses, or cauees ol action th::t may arise hncause ol installation <br /> �i d��-� and maintenance of ihe improvement or other riyhFol�way use hereto <br /> ��•=� ✓ �`F�—'l applied lor and Wrlher agrees to remove 5^me upon nolice irom ihe <br /> ApproveA lor Constru io i �a�� City and to replace public property damageJ ihereby. <br /> (� � l� -Z�-f�5�, �� \/�,/f��/ �.� <br /> �.AL IIJSPECTION ���'- ���e--��E�%�%P-`""—� 3 ��� <br /> Approved as Con,iructed ignalure ol Applicant Date <br /> cvcrett PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED I)�THIS PERMI7 MUST B[ STARTED WITHIN <br /> 1&0 DAYS OF DATE PE!iMiT IS ISSU�D AND THERE/1FTER IS TO <br /> � 3200 Cedar Streel BE DILIGENTLY PURSUED TO COMPL ETiON. T111S PERMIT MAY BE <br /> Everett,W�99201 CANCELLED BY THC CITY UPOIJ ANY STOPPAGE OF WORK ON THiS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br />