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CAppllutlm For <br />� PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257•8810 <br />TYPE OR PRINT ONLY <br />Owner <br />Applicant <br />Describe Proposed Work _ <br />Plan Checic No.: <br />]ob Address: <br />Ownef: <br />Tenant: <br />ApplkadOn Dete: <br />Proposed Use: <br />Type of work: <br />l9909-029 <br />S12 WiNTON AVE <br />GEARY DAVID <br />s/ia/� <br />SFR <br />ADDITION <br />Offlce Sd Job Sef Fre/Planning Sek <br />APProved For PermR: Date: By: <br />PROJECT ADDRESS (if known) <br />Dete"� <br />Publk Wotks Pertnit N <br />Building Pertnit N _ <br />Pubiic Works Fee $ _ <br />Phone <br />Phone <br />Attach lour (4) capfes piaris lOr proposetl v+ork - Draw to acale aiW note lhe I011owing il applicable: <br />• Pioperty Llnes • Outline and dimenslone of ell axistlng and proposed stniclures on the lot • Existlng and proposed ublitles <br />• Centerline of atrsat • IrMieate NOM • Show any propoeed 9radi^9 changes • Show measurements <br />DO NOT WRITE BELOW THIS IINE <br />PERMIT CONDITIONS: <br />1. All calis (or inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be peAormed in accordance with this permit and current City oi Everett Design and <br />Construction Standards and Specifications. , <br />3. Call Location Underground Service 48 hrs. before you dig. TOLI FREE NUMBER 1-800•424-5555. <br />?UDLIC WA� UIRt RMI', <br />noi�bY._�— <br />• A1 E . _— ����— --' <br />—7 ��c�..2 5� c�c��' <br />.� r�e�-� U'f�G . <br />prove or ns ruc ion a e <br />FINAL INSPECTION <br />Appraved as Constructed <br />Date <br />c,J hq�G cM c�e+' nC� T.+��30 r� <br />�,,�1 ,�,.r�� a�c. ,a2u�+J✓ <br />W <br />� <br />� <br />N <br />� <br />Y/ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownerlapplicant hereby aqreos to hold end save hartnless <br />the Ciy of Everett Irom any and all clalms for demages, costa, expenses, or <br />causes ot ectlon Nal may arise because ol inafallatlan and maintanance of the <br />Improvement a other right-of•way use hereW epplled for and lurther aprees ro <br />remove seme upon noNce irom the City and to replece public p�aperly dem- <br />aged thereby. <br />gne re o ican <br />WOFiK AUTFIOH�O BY7HIS PERMR MUST BE STMTED WfTHIN 180 DAYS OF MTE PEF�MT IS ISSUED M1D 1}EFEAFIER IS TO � DllOENiLY PURS.ImTO <br />COMFi.El10N. T}MS PERMR MAY BE CANCEIlED BY T}£ CffY UPCXJ ANY STOPPMDE OF NK)FiK ON TMS PRQECTOVER YO DAYS DURATifXd <br />