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Date B-Z�- TO Pf�ST�NG- -1��'T <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Gordon <br />Cwner <br />189th S[ SE .Bothell 98 <br />ling Address � City <br />� � <br />Describe Proposed Work <br />new SFR .— <br />i.nt 3 of Shore <br />Prolect Address (if known) <br />5111 <br />A.m <br />� � 3oa / <br />>u��¢ Works Pe�mn • <br />mea o�c�.• 37823 <br />1 PuObc WOIXf Fee s <br />Totei Fne <br />Less �uo�. Fee P� 1 S.—�� <br />' ' - ' Beience Dm s �Q �� <br />` , OU2-342yoi�d'3/ <br />Attach lour �4) cop�es oi plans for pmposed work • Draw lo scale and note � CQo1�edine of stree't able: <br />� Property lines � Indicale Norih <br />• Outline and dimensions ol all existing and � Show any proposetl grading changes <br />proposed sfructures on the lol � Show me2surements <br />• Existing and �roposed utilities <br />rnone <br />Phone <br />PERMIT CONDITIONS <br />1. All ce�ls for inspection shell be made 24 hre. in advance • phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and current City of Everett Design end Conslruction <br />Slendards and Specificatlons. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800'4i4•55 . <br />� /�-/i�_Line rau� o�rar�s io Sfo�••� D.-P.� i;, Sov.,� �v<, <br />/7�ec� {d inS7`a �L 4 fn fc i+ t%rSi., in Jouno� 4ve. Cir'ni �cyC <br />L<l�l` <br />s' J�f�/'� fo Mo�c ConnC�f�O�•) <br />S. f�s r�vch r4:.,�uafe.- hUnnof{ �S �oss 6�c /�ast 6e <br />di�-cc��d �'n i/x f�f�-C.n� SysYcm. <br />(��7lo-c-� 8 J� %Z <br />Approved lor Construction <br />Date <br />� <br />,�%��'l� /O —/ z ' l�3 <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />�PUBLIC WORKS UEPARTMENT <br />3200 Cedar Streel <br />Everett, WA 98201 <br />Phone:259-0810 <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees lo hold ana save harm� <br />less lhe Clly ol Everett from any and all claims for damages, costs. <br />exPenses, or causes of adion ihat may arise because of installation <br />and maintenance ol lhe improvement or o�her right�oFway use hE•eto <br />apPlied for nd lu{Iher rees to remove same upon �otice irom t1e <br />City and repl e pu property damaged ihereby. <br />� <br />Date <br />Signalure I pplican <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />