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D8te3/20/86 <br />Application For <br />PUBLIC WORKS PERMIT- <br />Print or Type Only <br />_. _...., . _. _ <br />_- ----._ _ _ � .�. <br />Pu�lic Worna Permll • �/ � � /�� <br />eieq. oaPi.. 86/16259 <br />Pueli<workaFea � <br />To1el Fea _ <br />Leaa ApD� Fea VaiE S <br />Balence Dun S 2�% �^� <br />TPHA�n� I`n..et.-....o-i.... r., 1A90d An h 17_+..er �F Hy� A th 17 OAM9 dRl aaaa <br />Owner Mail�ng Address Ci!y Zip Phone <br />Same as above <br />Applicant Mailing Address City 2ip Phone <br />neecribe Proposed Work �nstruct single family residence — Basic Plan 1228 <br />Lot �8 Willow �eek Glen <br />r!oject Address (it known) <br />Attech four (4) copies o( plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions ot all existing nnd � Indicate North <br />proposed struc}ures on the lot • Show any proposed grading changes <br />• Existing and proposnd utilities • Sho.v measurements <br />PEflM1T CONDITIONS <br />1. All calis for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. l�II wark sha�l be pertormed in uccordance with this permit and c;irrenl City of Everett Dasign and Conatruction <br />Stanaarils ar.d Specifications. <br />3. Call Location Underground Service 48 hrs. before yuu d!g. TOLL FREE NUMBEA 1•800•4L4-5555. <br />� <br />V <br />��oa-�' �3 2Si �� <br />Approved for Construction ate <br />%���i�� %-.� �_��� <br />L IFifS�NSPECTION Date <br />Approved as Constructed <br />everett PU6LIC WORKS DEPAqTMENT <br />� 3200 Cedar Street <br />Evereti. N/A 98201 <br />Phone: ?.59•A87 5 <br />ACKNOWLEDGEMENT (�F CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ,wner/applicant hereby agrees to hold and save harm- <br />less the City uf Everett from any and all claims for damages, costs, <br />expenses. �r causes of action that m�ry arise because of installal�on <br />and maintenance ot the improvement or otnar right-of-way use hereto <br />applied for and furtier ac�rees to remove same upon notice from the <br />Ciry and to replace public property damaged fhereby. <br />�- <br />gn2fure of pplicant Date <br />WORK AUTHORIZED B`: THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUEC AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLET!ON. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAG� OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />