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9-9-92 x'�3 ' �C–q—� PUGIicWorkaPormil• �G � / ' <br /> Dete Bie�oec�.• 37956 <br /> , , AppliCetion For <br /> PUBLIC--WORKS PBI�I�KTN� �" � -�t'� °°°.o�FeeF~ _ <br /> Len Aoo�Fee Paia = � <br /> . ' :� C, � Bal�nceDue f <br /> Print or TyPe Only � ' ` ` '', ` ' ' �' <br /> c- � <br /> Jim Langue 904 Westminster Cirele � ' Everett WA 98203 2Zp-6226 <br /> r^ - �-MeiMjgAddress'�. '., CitY Phone <br /> Owner ��� � , - <br /> ci � .� <br /> �, r: , �� , . . . <br /> Gl¢n Olin 337�$,451��'� "' �' "' `�� ' � �� � � Z�p phone <br /> Applicant Mailinp Address City <br /> psscribe Proposed Work <br /> nev SFR <br /> Lot 4 of Beckenwood � <br /> • '\J—c � <br /> Project Addresa(it known) _ � <br /> � <br /> Attach four(4)coplea ot plans for proposed work•Draw to scale and note the following as aAPlicable: � <br /> • Property Lines • Centerline of street <br /> • Oulline and dimensions ot all existing anE • Indicete North <br /> proposed strucluree on the lot • Show eny proposed greding chenges <br /> • Exiatinp and proposad utilltles • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CANDITIONS � <br /> 1.All calls fw Imp�ction ehall ba made 24 hrs.in edvence•phone 259$810. <br /> 2.All work�hall ba psAormed�n accordance wHh this permit and curtent Clty ot Everett Desipn and Conatrudiun <br /> Standerds md SpecBic�tlona. � <br /> 3.Cell Laatbn Undsrpround Service 48 hre.before you dlp.TOLL FREE NUMBER 1-800�4245555. <br /> 4, G" �� s-r0 #.307 D/ZIV�v�-! ��� ��+ X��n��►'� � <br /> Zo � ��� �� � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hcld and seve harm- <br /> less the City of Everett from any and all cleims tor Oamege& costa <br /> _ / expenses, or causes ot action Ihet may arise beceuse of instelletlon <br /> �-, and meintenence of the improvement or other right-of•wey use hereto <br /> applied tor and tuAher agrees to remove seme upon notice from tha <br /> Approv d for Co ucti a�e City and to replace pub�ic property damaged thereby. <br /> ��- G -� t�'3- � ,� C/ �� <br /> FINAL INSPECTION Date Date <br /> Signature o pplican <br /> Approved as Cc^structed WORK AU7HORIZED BY THIS PERMIT MUS7 BE STARTED WITHIN <br /> � PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CederStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8870 PROJECT OVER 90 DAYS DURATION. <br />