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� <br /> n U -3C� Za-4 q o � <br /> 1+'8te� PuD��c Work�Frrmh• <br /> Applicati�For eiea.oew.• q�};q <br /> PUBLIC WO�S PERM PublicWorh�Fn <br /> TO PO�NG �'� -� .a,.,F� : <br /> Leu Aoo�Fee P�ie 1 <br /> Print or Type Only � � g g g �g rj' 8 g r� B�bnceDue s ��— <br /> . � � »� x � � � � � <br /> Wilton Hutt PO Box 5458 Evere� WA 98206 44 6896'" <br /> Owner Mai��e������� i r`f Zip Phone � <br /> Peroe Const 4204 243rd P1 Ap � �4�� <br /> Applitent Mailing Address City Zip Phone <br /> Describe Proposed Work new house <br /> Lot 3 Short Plat 29-92 <br /> Project Addrean(il known) 40 f I V �� � <br /> � <br /> Attach four(4)copies ol plens for proposed work• Uraw to scale and note the following as eppliceble: � <br /> • Proparty Linee � Centerline of street � <br /> • Outline and dimensions ol all existing and • Indicate North <br /> proposed atructures on the lot • Show eny proposed grading chenpes <br /> • Ezisting a�d proposed utilities • Show meaeurementa � <br /> DO NOT WRITE BELOW TMIS LINE O <br /> PERMIT CANDITIONS <br /> 1.All c�lls for InspscNon shell be made 24 hrs.in edvance•phone 2S�88Z0. � <br /> 2.All work ahall be peAormed In accordance with thle permit and current City of Evarett Design end Conetrudion <br /> Stand�M�and Speclfkallona <br /> 3.Call Locetlon Underground 3ervice 48 hra before you dig.TOII FREE NUMSER 1•800�42455b5. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> .� ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby egrees to hold and save harm� <br /> less the City ol Everetl irom any and all claims for damages, costs, <br /> P� � � e■penses, or causes of aCtiOn that mey arise because ol installation <br /> G /.—/2 _!�� and maintenance of the improvement or other�ight•of•way use hereto <br /> � � � �pplied lor and further agrees to remove aeme upon notica !rom the <br /> Ap�ed lor Construction Date Ciry and to replace public propert em d thereby. <br /> / � <br /> �'`-��=-�-� �-1 Y-Qr � 3 c. <br /> FINAL INSPECTION Date <br /> Approved es Const�ucted �gnaWre of Applicent Date <br /> � PUBLIC WORKS DEPAFiTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE 5?ARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Eve:elt,WA98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phone:258•8810 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />