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TYPE OR PRINT ONLY <br />ff <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett WA 9=1 259-8810 <br />Ty POSTING ----- - <br />r PO Box 716 Everett 98206 252-3699 <br />Narnrg <br />Data 2-3-998 <br />(/ <br />Public Works Permit. : /&/ o%s <br />su"M Palh a 57804 <br />Public Works Fee $ LtU <br />Zip Phone <br />Owner <br />A,.,4icant Mailing Address City ZIP Phone <br />Describe Proposed Work new house <br />PROJECT ADDRESS (f known) A4 <br />hur-SL <br />4-20-178 1:05PM <br />H 57804 <br />A 57804 <br />r'lUI; D 1612.75 <br />PLUMB 77.00 <br />4.50 <br />Attach four (4) copies of plans for proposed work . Draw to scale and note the following 8 applicable: PLAk CK 223.44 <br />VroPerty Lines `Outline and dimensions of all existing and proposed strictures on the lot NExisti and 11 0686 <br />eCw. iterline of street Indicate North `Show any proposed grading changes °Show meaqu� Wj PIT Od <br />PERMIT CONDITIONS: IJTi_I7)' 1613.00 <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8816OTAL 4456.69 <br />2. All work shall be performed in accordance with this permit and currant City of Everett Design and--HEF <br />Construction Standards and Specifications. A CH55C3 <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-60g-424-55M. <br />4, In )-t7t G/ d.n/Lilllc 9,& _•M1.-✓/ d�;i� =t <br />vi{�,✓bl.z wart Hxc{ur %3t%-}o3J <br />S lasfa l ¢ rast-rf r evc-7 �a/ �: �u �v5 Cz t� -w ka , n j <br />d rV'GG fi 0» - <br />W <br />co <br />Ca <br />0 <br />M2 <br />O <br />a <br />. 1 F t��zfv; q> seder Cct n ► he 0 & � .� ed -4Y scr ✓Jt jc cj.r�l v <br />z p n vx 4t: <br />tT"i <br />AIX�J /U <br />roved for Construc%t' - e <br />INALINSPECTION Date <br />Approved as Constructed <br />M• N. 04 f`lt i 1 /074 wi lT -X r7tTw lywt! <br />f1� s»a,ti r�, au �v�1r� -C�•d; wt'� <br />ALVNOV M1EDGEMENT OF CONDITIONS <br />The the City E amen from t t �� agrees <br />to hold and save harmless <br />arty and all claims for damages, cosh, expenses, or <br />causes of action that may arise because of Installation and mskrtenanx @ of <br />the knprovement or other right-of-way use hereto app.. forandfurtheragrees <br />to ove��yupon notice from the City and to r@Pbos public property <br />darnag/1 <br />icant <br />Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DB.K/TLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />