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Application For <br />PUBLIC WORKS PERMIT Date <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8610 <br />3-4-99 <br />Public Works Permits _ j._ _ <br />Building Permit t <br />TYPE OR <br />I O <br />POSTING NOV i 8 2081 <br />PRINT 0VLI <br />Public Works Fee S _ !� <br />Jeff Gray <br />PO Box 715 Everett <br />98206 425-252-3699 <br />Owner <br />Mailing Address <br />City <br />Zip Phone <br />Owner <br />Applicant <br />Mailing Address <br />City <br />Zip Phone <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />new house <br />4637 Seahurat Ave Lot 4 SP #1-98 <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />*Property Lines "itline and dimensions of all existing and proposed structures on the lot 'Existing and proposed utilities <br />`Centerline of street •Indicate North -Show any proposed grading changes 'Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection 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 Underground Service 48 hrs. before you dig. TOLL FREE WWBER <br />1-86VU4-550. <br />LU <br />1021.75 <br />L'U118 <br />77.00 <br />HECH <br />60.00 <br />SRCHG <br />4.50 <br />DRIVE <br />20.00 <br />PLAN CK <br />30.00 <br />It <br />31977 <br />SEWER <br />70.00 <br />UTILITY <br />1296.00 <br />TOTAL <br />2579.25 <br />A OH 911 <br />(j) <br />ca <br />0 <br />z <br />0 <br />CO) <br />0 <br />a <br />CHEF: 2579.25 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Pjj I„ ,f The undersigned owner/applicant hereby agrees to hold and am harmless <br />the City of Everett from any and aN claims for damages, costs, expenses, or <br />Approfor Con t ion Date causes of action that may arias because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and fuller apses <br />�. _/3pG to remove same upon notice from the G.y and to replace public property <br />_ ! y damaged thereby. <br />FKAL INSPECTION Date <br />Approved as Constructed <br />3 ZS <br />reicant e <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE MR IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY 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 />