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PUBLIC WORKS <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />(425) 257-8810 <br />10STING- <br />nfvoAioaes`s: GOERTZEN HOLDING INC <br />11724 23RD DR SE <br />EVERETT WA 98208 <br />PHONE ( 425) 337-527'3 <br />TAX rARCEL I.D.x 22$0520220000 <br />PROPOSED!I'O K: NEW HOUSE - BASIC 2090 <br />PW <br />PERMIT CONDITIONS <br />Date 6/1/01 <br />Public Works Permit F PWO106-004 <br />Building Permit II C0106-002 <br />Planning Reference If <br />Public Works Fee $ $ 25 . 00 <br />0 9 240+ Guarantee $ <br />AND ADDRESS: - GOERTZEN HOLDING INC <br />11724 23RD DR SE <br />PHONE: EVERETT WA 98208 <br />(425)337-5273 <br />PROJECTADDRESS: 117?O 23RD DR SE <br />LOT 6 SHORT PLAT 12 <br />1. All calls for in! ,n shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall, erfermed in accordance with this permit and current City of Everett Design and Construction <br />Standards am Jecitications. <br />3. Call Locatio, . riderground Service 48 his. before you dig. TOLL FREE NUMBER 1-800-424-5555 <br />4. Connect side sewer to house per City of Everett Standard *601 <br />5. Install splash block or drywell to accomodate roof -top runoff <br />/ <br />/Cppr00%*1I fforr construction Date <br />_/�P-yYLl.�r.^' //— r, <br />FINAL INSPECTION <br />Appioved as Constructer Date <br />06-15-01 <br />12:09PM <br />if <br />106002 <br />EUila <br />1240.11 <br />SRCHG <br />4.50 <br />PLUMS <br />98,00 <br />DRIVE <br />25.00 <br />MECH <br />80.00 <br />if <br />106007 <br />WATER <br />130.00 <br />SEWER <br />70.00 <br />UTILITY <br />1613.00 <br />TOTAL <br />3260.65 <br />A OM3288 <br />E <br />Uj <br />F- <br />005 <br />W <br />O <br />00) <br />O <br />VI <br />0 <br />CHEI-: 3-0-65 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The Undersigned owner/applicant hereby agrees to hold and <br />save harmless the City of Everett from any and all claims for <br />damages, costs, expenses, or causes of action that may arise <br />because of installation and maintenance of the improvement or <br />other right-of-way use hereto applied for and further agrees to <br />remove same upon notice from the City and to replace public <br />Prof V d thereby. __ (//�j � S ///� <br />S_.a nt Date '_".'—"_ / <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED <br />TO COMPLETION. THIS P'_RMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />