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A <br /> � , . <br /> _ _... _ . . ._ _ .._ ,. w.; .. <br /> � PUBLIC �►rORKS PERMIT <br /> Dat� 3-1$-9i <br /> r � �� �n <br /> PUBLIC WORKS DEPARTMENT Public Works Permit# <br /> 3200 CBdar Street <br /> Everett,WA 98201 259•8810 Building Permit N 54551 <br /> TYPE OR PRINT ONI_Y public Works Fee$ Z�i <br /> - i <br /> i)ennls �iaher PO Box Ift24 S�:verett 982U6 252-6375 � <br /> Owner MailingAdd�ess � ._ : :City '_ - �� Zip Phone <br /> rJ <br /> R G R Con�t J11]. LucuF 'L52—G376 - <br /> Applicant Mailing Address "� ��City Zip Phone � <br /> Describe Proposed Work_ new house (replacing demo'd I�ou�a) I�I <br /> � i <br /> '�� � L � <br /> PROJECT ADDRESS(if known) � -- �Z � --�� �� S� I <br /> ,4ttach tour(4)copies of nlans for proposed work-Draw to scale and note the following if applicable: � <br /> •Property Lines •Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities O <br /> •Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CC'JDITIONS: � <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and O <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> fi' _ r.%i7i9CG l- �'lJ��rJ� / c'. i ; %;'� L � � _ V♦ <br /> � � D �� �iC _ 2u-E y- <br /> ,. / - � O <br /> - . .��i cJ r-:�C7�c/ ,��i �t- C �;� � <- �'�' ���! � <br /> �, '' <br /> ' � / � ,- ACKNOWLEDGEMENTOFCONDITIONS <br /> '���/,� `/ C �� The undersigned ownedapplicant hereby agrees to hold and save harmless <br /> '�"-'" ��� �- ��jL,f" �7 the City of Everett from any and all claims for damages,costs,expenses,or <br /> Approved for Construction Date causes of action that may arise because of installation antl maintenance of <br /> the improvement or other right-of-way use hereto applied for and further agrees <br /> to remove same upon notice fiom the City and to replace public property <br /> dama�by. <br /> FINAL I�SPECTION Date <br /> Approved as Constructed ,_� _ . ..-� <br /> �- � y"-i�, - y 7 <br /> � i�ure of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DUMTION. <br />