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Da;e 3-16-93 M _�U_z�� "�J a/����l /) <br /> Puolic Works Permlt• I✓ �� / <br /> Application For eieq o�o�.• 39903 <br /> PUBLIC �'�/ORKS PERMIT PuEbcWorksPoe <br /> Tn P�STING �-,� �.9� =o„�F« s <br /> Less aooi.Fee vro S <br /> Print or Type Only Ba�a�=a o�e S 2�� <br /> W.D. Rucker 20115 44th Ave W Lynnwoad WA 98036 774-Sui6 3bY�-YjLoo <br /> Owner Mailing Address City Zip Phone <br /> Owner <br /> Applicant Mailing Adtlress City Zip Phone <br /> Describe Proposed Work new house <br /> Prolect Address(if knownl �� ��� ��� Dr��a � <br /> Altach lour(4)copies of plan5 lor proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline ol st�eel � <br /> • Outline and dimensions ol all ezisting and • Indicate North <br /> proposed structures on the lot • Show any proposed 9rading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> � ' PERMITCONDITIONS O <br /> 1.All calls for inapection shall be made 24 hrs.in advance•phone 259•8610. � <br /> � 2.All work shall be pertormed in accordance with this permit and current City of Everett Design entl Constructlon <br /> Standards end Specifications. <br /> 3.Cell Location Underground Service 48 hre.before you dig.TOLI FREE NUMBER 1•800�424•5555. � <br /> �}� �r.��u�' mueFi lw p��osUtd. -to obsarv� c��ed„�q -(or �u�-(orma.�ic �Ple�. � <br /> 5� fk�� worK mU�t Gon-Form ko .(�,G �2/4 ' AFaIZl1 �co-54a,d�.� . <br /> G. /�n �5� �rmah� 7hatl (� ��c�d.. � <br /> �, All �sA'7 tihall Iw s;�j�cd o�.yy 3�t. AIn�� P.evti,etcv. � <br /> �. q�;�iorial GYbSb'I Go�� �'r��a9uv�5 shatl b� �nytei�cd as d�ru,f�d• O <br /> a� U�l�b1 u�rrt�or 4� dr;�t��/ ��t 3� stiail �Z r�5+�rcd�rwr.q�taet�d a <br /> �0� �{vv�e M�s(> bo yPv��Klwed. ' �a � I�ud <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> - less the Gly of Everetl Irom any and all claims for damages, costs, ' <br /> ' %_��'��� expenses, or causes ot ac�ion ihat may arise because of installation <br /> �i7 / � and maintenance of the improvement oi other right�ohway use hereto <br /> Approv orConsi h � applied for and luriher agrees to remove same upon notice irom the <br /> �� � ate City and to replace public property damaged ihereby. <br /> �--����4;��-- 6-�-sJ- <br /> FINAL INSPECTION �pa�� L'�7Z�,`:{ <br /> Approved as Consiructed ionature ol ApplicaN Date <br /> � PUBLIC WORKS DEPARTMENT ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 8E DILIGENTLY PURSUED TO COMPLETION.THI.i PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />