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3�����i� � pu�ecPJurkcvmmiiv `� I —I � <br /> Date aiao oco� • 84�1'032 <br /> � <br /> APPlicati�n For <br /> ����CS pERMIT PuolicWorxaFee 5 'J�.O •� <br /> F'���'� Taial Feo <br /> Les•.ApOI Feo Pa�� S� G O <br /> Balanc:Oue <br /> $ �——_ <br /> Print or TypE: Only G S/ �'3 <br /> Robert =. Friede 221 S.E. Everett fdall Way M-2 <br /> �i8204 776-75�4 <br /> Owner Alailing Address <br /> City Zip Phone <br /> Same – phone <br /> —�— Mailing Address <br /> CiIY Zip <br /> Applicant <br /> New Single Family Resideno_�_ <br /> Cuscribe Proposed Work ._-- <br /> �----' <br /> � <br /> /vl� c / io -�• �. � <br /> Prolect Addrecs(if known) er <br /> Atlach four(4) cooies of plans tor proposed work- Draw to scale and note Q Ceniterlire of street able: – S <br /> V♦ <br /> O Property Lines p Indicale North <br /> 0 Oulline and dimensions of all existing and O Shov� ar.y Froposed gra�iing changes � <br /> proposed struclures on the lot � Show measurements <br /> • Existing and proposed utili ies �����, <br /> Dp �'7T WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 259-8815. ,� <br /> t. All calls lor inspection shall be m2de 24 hrs. in advance- pl�one � <br /> 2. All work shall be performed in acco:o3n�e Nti!h this permit and c�rrent City of Everett Design and ConsVuction � <br /> StandTrds and Specifi:ations. � r <br /> 3. Call Localion Under9round Service�d hr�. be:ore you dig.TOL:FRE[ NCMBER 1•800•424•5555. `. <br /> � <br /> �� r� i-. <br /> � � <br /> � H � <br /> l7 �C <br /> � � r. <br /> c. <br /> � � L <br /> p r <br /> C � <br /> � � <br /> AGKNOWLEDGE6IENT OF CUNDITIONS y <br /> licant hereby agrees tc ho:d and save harm- K <br /> The undersigned own=_r/apP � �,: <br /> -- less the City of Everetl irom any and all claims for damages, costs, <br /> — ^G� exPenses, or causes ot actbn lhat maY arise 6ecause of installation �TJ E: <br /> � j ��_� and maintenance ol the impuvement or other righFof�way use hereto <br /> applied tor and turther agrees to remove sam? upon notice Irom the � C <br /> Dat Ciry and to replace 'c property damaged thereby. t� <br /> . Approved r etion /, � 1, �/ t� i�� <br /> Q � 5 I�l ` C� /� .'�� rx f `�. � c.�, <br /> Dale � - , Datcl �+ ra <br /> F1NAl PECTION Signat otApP • ..; <br /> Hppruved as Constructed ypOR AUTH�RIZED 3Y THIS PERA�IT MUST BE STARTED WITH�N � K� <br /> everett PUBLICVJORKS DE.•ARTMENT 180 UAYS GF DATE F9RMIT IS ISSUED AND THEREAFTER IS TO � <br /> � 3200 Cedar Street 0E �ILIGeNTLY PURSI ED TO COMPI.ETION. THIS PERMIT MAY BE _' <br /> Evy�elt,WA 99201 CANCELLtD BY THE Cll�UPON ANY STOPPAGE OF WOAK ON THIS <br /> Phone: 259-8815 ?ROJECT CV�R 90 DAYS DURATION. ,.1 <br /> :� <br />