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•- ��uo�Fa� 4/16/96 <br /> G��� PUBLIC V1�JRKS PERMIT Dale_ <br /> F PUBUC WORKS DEPARTMENT Public Works Pertnit q <br /> 3200 Cedar Street S��9 <br /> Everelt,WA 98201 259-8810 Building Permit il <br /> Public Works Fee 5 — <br /> TYPE OR PRINT ONLY <br /> MCKINLAY ROSIE & llRENT 7610 TYEE RD EVERETT 98203 phone <br /> Owner <br /> Mailin9 AdJress City Zip <br /> K–FOIIR CONSTRUCTION 668-2000 <br /> Applicant Mailing Address <br /> City Zip Phone <br /> Describe Proposed Work ADDITION TO HOUSE � <br /> � <br /> �� <br /> Y/ <br /> PROJECT ADDFESS(if known) W <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the following if applicable: O <br /> •Property Lines 'Outline and dimensiors of all eaisting anC pr000sed structures on the lot •Existing and proposed utilities � <br /> •Centedine of street 'Indicate North •Show any pmposed grading chan�es •Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: O <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-88 i 0. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> O <br /> a <br /> ��UBLIG WORKS PEHM1� <br /> NO� EOUIREQ <br /> '-Y—�-= -- ' <br /> aATE_��G ��-- <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harmiess <br /> the City of Everett trom any and all clalms tor damages,costs,expenses,or <br /> causes of aclion ihal may arise because of installation and main[enance of <br /> ApprovedforConstruction Date Iheimprovementorotherright-of-wayuseheretoappliedforendfurtheragrees <br /> to remove same upon notice irom lhe City and to replace public property <br /> damaged thereby. <br /> FINAL INSPECTION ���e <br /> Approved as Constructed Date <br /> Signature ot Applicant <br /> COMPLETION.RTHES ERMIT A1AY BE CANS HE CITYIUPON ANY S�TOPPAGE OF WI ORK ON THIS PROJEC OVER 90 DAYS OULRATION.Y PURSUED TO <br />