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� <br />� <br />TYPE OR PRINT ONLY <br />Appliceti0n Fa <br />PUBLIC WORKS PERMIT <br />SELCO DEVELOPMLII'_ <br />PUBL�CWORKSDEPARTMENT � <br />9200 Cedar Street <br />Everett, WA 98201 259•8810 �p � � <br />TO POSTING "_--- <br />PO BOX 1524 SNOHOMISii WA 98201 <br />lailina Address City <br />�— <br />�e�e 10/16/97 <br />Pt bi�c Works Permil N 33 <br />Building Pertnit � 56814 <br />. <br />Public Works Fee S �� <br />Phone <br />CONTACT: BRUCE SELIN <br />Applicant Mailing Address City Zip Phone � <br />Describe Proposed Work <br />NEW HOUSE - BASIC 1248 <br />PROJECTADDRESS(ifknown)�a�371�eP I��� �+"�`"�- � �' Z' P� <br />Attach four (4) copies of plans for proposed work - Draw to scale and note lhe following il appiicabk: <br />•Property Lines 'Outline and dimensions o1 all ezisting and proposed struclures o� ihe lot •Existing and proposed utilities <br />•Centerline of streel •Indicate Norlh 'Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for in�pection shall be made 24 hours in advance - phone 259-8810. <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 Unnemround Sarvice 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-u55• <br />�, CQ,y�n,p�� ►'t�o� �c+w/�Spo"ts ia _Sic�es�-��! <br />j � 5i de;e�-cY �e� �5 �� ��l <br />10-23-97 <br />It <br />EUILD <br />FLUMR <br />HECH <br />SFCHG <br />CN2IVE <br />H <br />IIATER <br />a <br />5EWER <br />UTILITY <br />TOTAI <br />11:54AM <br />56814 <br />673.75 <br />63.00 <br />60.00 <br />4.50 <br />20.00 <br />9557 <br />650.00 <br />31304 <br />�o.00 <br />1296.00 <br />2837.25 <br />� <br />O <br />�/� <br />V♦ <br />O <br />a <br />CHEF: �837.25 <br />ACKN.'�. 'DGEI��¢BNDITIONS <br />The undersigned owne �r:. "ent hereby egrees to holC and save hartnless <br />the City of Everett har �:� ,��id all claims for damages, costs, ezpenses, or <br />causes of action that r-�, .�ise because of installation and maintenance of <br />iheimprovementorotl„ 'r7l-ol•weyuse`oretoappliedforandfurthera9re9s <br />lo remova same upon notice from the City and to replace public rrope.ty <br />dam ihereby. 1 <br />! <br />� //�( .,� �!/`L 7 w � •- <br />Signatum of Ap`plican C��,� ate <br />-�b" <br />WOHK AUTHORIZED BY THIS PERMIT MUST BE STAPTED WITHIN 100 DAYS OF DATE PERMIT IS ISSUED AND iHE R IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF 1YORK ON THIS PR0.IECT OVER 90 DAYS DURATION. <br />