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Date <br />Application For <br />PUBLI�C WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />Prolect Address (if known) <br />Plan Check No: C 40605 SEYA <br />Applicat.Date: 12/30/94 <br />Job Addrs: 2716 19TH ST <br />Owner: DADVAR BEHNAM 4 <br />Tenant: <br />Proposed Uae: SIN:,LH FAMILF RESIDENCE <br />Deec. of Work: <br />COMPLETE GUTTEF) HOUSE <br />OFFICE SCT JOB .`aET <br />APPRVD FOR PERMiT: UATE_/_/_ gY <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions o( all existing and <br />proposed slructures on the lol <br />• Existing and proposed utilities <br />PUEIic Wo�Ms Permlt • <br />eieq. o�oi. r _ <br />Pub1�c Works Fee S <br />Totai Fee <br />Le55 ApO� 4e PaiG $ <br />BalancaUue S <br />• Centerline of street <br />• Indicate North <br />• Show any proposed yrading changes <br />• Show measurements <br />?hone <br />Phone <br />PERMIT CONDIT�ONS <br />7. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All �Hork shall be pertormed in accordance with this permit and current City of Everelt Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800-�124-5555. <br />'UBLIC WG+RKS PEPMI, <br />h�f REOUIRE� <br />> y�� <br />� ATE �>' , � _._..._� . <br />Approved for Constr�ction Date <br />FINAL INSPECTION Jate <br />Approved as Constructed <br />����PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone:259-0870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant her�by agrees to hold and save harm- <br />less the City ot Everett Irom any and all claims for damages, costs, <br />ezpenses, 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 turther agrees to remove same upon notice from ihe <br />Ciry and to replace public property dama9ed thereby. <br />5ignature ol Applicant ""` <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />HE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />