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Date 9�6�85 <br />Application For <br />PUBLIC WORK� PERMIT <br />Print or Type Only <br />John Adams 1i311 Cady Road <br />�� 3.1 —�: j' .i <br />PUEIic WoeFs Permi� • �� ��Q� <br />e�ao. oent. x 85/153£38 <br />PUEIic Worka Fea <br />Tolal Fee S <br />Lass AppL Fee Peitl S. �O_�_ <br />BalanceDue S. � <br />7s <br />Everett 98203 252-9065 <br />Own�er MailingAddress City Zip Phone <br />Williams Const. Co. 232 S.W. 43rd Renton 98055 :.-5757 <br />Applicant Mailing Address City Zip Phone <br />C'onstruct Single Family Residence <br />Describe Proposed Work _ <br />Project Address (if known) <br />Attach (our (4) copies of plans for proposed work • Draw tc scale and note the following n^� applicanle: <br />• Property lines • Centerline of street <br />• Outline and dimens:ons of all existing and • Indicate North <br />proposed structures on the lot � Show any proposed grading changes <br />• Fxisting and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 txs. in aAvance • phoi�e 259•8815. <br />2. ^II work shall be performed in accordance with tM�s Fermit and current City ot Everett Design and Construction <br />:;tandards and Specificationa <br />3. Call Location Underground Service 48 hrs. beforE you dig. TCLL FREE NU'rEBER 1•800•424-5555. <br />Approved for Consiruction� � Date <br />� ll�� � _^t �-fJ <br />FINAL IN CTIO� Date <br />Approved as Cor;tructed <br />everett � PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98207 <br />Phone: 259•887 5 <br />ACKNOWLEDG�.:MENT OF CONDITION5 <br />W <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett frum any and all claims for damagea, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agraes to remove same upon notice irom the <br />City and to replace public properry damagetl ihereby. <br />�� <br />Signatur� o pplicant Date <br />WORK AUT ORIZED BY THIS PE MIT MUS7 BE STARTED WITHIN <br />180 DAl'S OF 6ATr PERh11T IS ISSUED AND �THEREAFTER IS TO <br />BE DILIGcIJTLY PLIqSUED �TO COMPLETION. THIS ?ERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOI'PAGE OF WORK ON THIS <br />PROJECT OVER 90 DA � 5 DURATION. <br />