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1/19/94 u �/I� C� �ublicWadeParmd• �� —� <br /> Date �0 POSTING �---- 432'0 <br /> . e�av oso�.• <br /> Application For � <br /> PUBLIC WORKS P�RMIT °°°°""°'"="a <br /> Tolel Fee s <br /> �p Less PoO��Fee Pa�d S <br /> p � � � Q � � � � ^ o Ba�ance Oue S � ! <br /> Print or Type Only o p a v� <br /> �OInpm � � NM � .M-id <br /> � M N N M N N M m .ti <br /> M <br /> Charles Jolley 4801 Seahurst Av�e �verett 98203 �52-1�0 <br /> Owner Maiting Atldress\ � M r = C�� � � ��P Phone <br /> so� <br /> � � A� c� � � .�. 1�1 <br /> Same � S3a � 3� m � .• t5 <br /> Applicant Mailin�Address City Zip Phone <br /> Describe Proposed Work <br /> New house <br /> W <br /> Project Address�if known� 4729 SeahuTst Ave _ � <br /> Attach lour�4)copies ol plans for proposed work- Draw to scale and note Ihe lollowing as applicable; � <br /> • Properly Lines • Centerl�ne of street � <br /> • OuUine and dimensions of all exisling and • Indicate North <br /> proposed structures on the Iot • Show any proposed grading changes <br /> � Existing and proposed utilities • Show measuremenis M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be peAormed in eccordance with this permit end current City of Everett Design and Construction <br /> Standards end Spetifications. � <br /> 3.Call Location Underground Service 48 hre.before you dig.TOLL FREE NUMBER 1-800-4245555. <br /> O <br /> � <br /> � <br /> O <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersi9ned owneqappliwnt hereby agrees to hold anA save harm- <br /> less ihe Gity ol Everelt Irom any and all claims tor damages. costs. <br /> P�� expenses or causes of action that may arise because of installalion <br /> �(/_�_ 1_3�_ q�f and maintenance ot Ihe improvemen[ or olher righbohway use hereto <br /> �Xv� applied lor and luriher agrees to remove same upon notice irom the <br /> qpproved lor Construction ���e Ciry and to replace public property damaged ihereby. <br /> �/��l' � �y_ 4� �� a�� Z/a q U <br /> Date �� <br /> FINAL INSPECTION Signature of Applicant ` ate <br /> Approved as Conslrucled <br /> W O R K A U T H O R I Z E D B l' T H I S P[RMIT MUST BE STARTED WITHIN <br /> �A1I� PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PEF`MIT IS ISSUED AND THEREAFTER IS TO <br /> 32o0CederStrect BE DILIGENTLY PURSUEJ TO COMPLETION.7HIS PERMI7 MAv BE <br /> Everett.WA 98201 CANCELLED BY THE CI'V UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />