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Date 4-7-94 <br />�C� P05TING �-2� -qs <br />Application For �, <br />PUBLIC WORKS PERII�IT <br />Q <br />G <br />n <br />Print or Type Oniy � <br />ll. <br />� <br />t <br />Larry Van Horn 8419 9th Ave SE Everett WA�� <br />Owner Mailin� Address o� �� : <br />Owner <br />Applicant <br />Describe Proposed Work <br />Projecl Address (if known) <br />Mailing Address <br />detached <br />8419 9th Ave SE <br />0 o a o <br />r�tnain <br />tiF �F O O� <br />� �, �., ,� <br />,:� . , <br />Ai M <br />Ci�t _ <br />m r� 3 u <br />[� U� � LLI <br />J ir Z <br />GiGiOU <br />�'�' <br />Attach four (:) copies of Flans for proposed work - Draw to scale anti nol^ the follow;,,g as applicaGle: <br />O Property Lines <br />• Outline and dimensions ol all existing and <br />proposed slructures on the lot <br />• Existing and proposed utilities <br />, <br />� f <br />Publ¢ WorAs Permll a � <br />Bltlg. Dep:. s �i3 <br />PubLc Works Feo <br />Total Fec S <br />LessAppL Fee Paitl S <br />eaia��e o�� 5 �C oa <br />ooZ -.�2� �/a /�B� / <br />• Centerline of sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Shov+ measuremen�s <br />rnone <br />PERMIT CONDITIONS <br />7. All calls for inspection shail be made 24 hrs. in advance- phone 259•$810. <br />2. All work shall be performed in accordance wilh ihis perrnit and current City of Everett Design 2nd Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800-424•5555. <br />7, ! GLL�'. Cl/LLci`et.ti'ci�i Q�J�^U�� /Yl �JLiG�/G ��l�j��—OT—Cc/c��/ <br />Q ✓ � <br />�./- ��2. `-� ia � 't <br />ApP�ov r� tor Construction , ate <br />L /�-� //��.���i,' �/�,� �> <br />FINAL INSPECTI��� `���ate I <br />Approved as Constructed <br />'. PUBLIC WORKS DEPARTIdENT <br />/� 3200 Cedar Street <br />� Everett, WA 98207 <br />Phone:259-8810 <br />ACKNOWLEDGEMENT OF CGNDITIONS <br />1 � <br />� <br />�L J <br />The undersiqned owne�/applicant hereby agrees to hold and save harm- <br />less the Cily of Everett from any and all claims for damages, cosls, <br />expenses, or causes of aclion that may arise because ot installation <br />and maintenance of the improvement or olher nght-obway use hereto <br />applied tor �antd further agrees to remove same upon notic� from Ihe <br />City and iry�yplace puj3lic property damaged theieby. <br />SfgnaWrpr I Applicant / Dat'e <br />WORK/ THORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br />180 D' S OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br />BE 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 />