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1/l6/86 <br />Date <br />Appficatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type O�ly <br />Rogers Construction 11303 9th Place West <br />MaiHng AtlJress <br />City <br />Everett <br />PuElic Works Permit r �� �� <br />eiea.o,p�.• 86/83165 <br />PUCIic Worb Fee <br />To:al Fee : <br />Lesn ApO� Fee Peld S <br />ealence Dua s ��— <br />98204 347-1832 <br />Phone <br />Same <br />Applicant Mailing Address Ci:y Zip pho��e <br />Construct Single Family Residence <br />Describe Proposed Work <br />Project Address (if known) <br />Attach tour (a) copies of plans for proposNd work - Draw ti: scaie and note the following as applicable: <br />• Property Lines <br />• Outline a �J dimensions of 211 axisting and <br />proposed structures on the Ict <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />vi'�3�- �c//Ct�4;� <br />• Centerline of street <br />6 Intlicate North <br />• ShoH�zny proposed gradin� changes <br />• Show mea�ureinents <br />1. All calls for inspe�tion shall be made 24 hrs. in advance - phone 259•8815. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications <br />3. Cali Location Underground Service 48 hrs. before you dig. TOLL FRFE NUMBER 1-800•424-5555. <br />� .�C�i �c��� //�i' 8 6 <br />ApprovedforConshuction Date <br />� /�.�1����-0� <br />FfNAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />ACK.MOWLEDGEMENT OF CONDITIQ"!S <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned o�Hner/applicant hereby agrees to hold and save harm- <br />less the City of Evc.rett irom any and all r.laims for damages, costs, <br />expenses, or causes of action that may arise because oF insta�lation <br />and maintenance of thu improvement or other right-of•way use hereto <br />applied for and further a�rees to remove same upon notice from the <br />City � to replace public property damaged thereby. <br />ign .ure r�Abplica@C/ Date <br />! <br />K AUTF'ORiZED BY TFIIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS 0�= DATE F'CRMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLi PURSUED TO COMPLETION. THIS P:�!.i1T MAY BE <br />CANCELLED BY THE CITY UFON A�Y STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />