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Iss <br />Public w <br />Date4-16 94 ^� BldgDookerermna <br />Application For <br />TO POSTIIA Ot . _ 4412E <br />PUBLIC WORKS PJRMIT PuOTo Werke Fat <br />Totes Fee • <br />O Lett APxi Fee Pe !r S �f <br />.lance Due sir ,�— <br />Print or Type Only 8 g g S <br />M o ,Q o troa.gq�r <br />C <br />o N <br />Withers Construction 21611 45th A%r6 S$a Bothell 980n 4rg1-45a Prone <br />Owner Malting Atldress Cilfs �ip <br />trier <br />--tpphcant Maumg Address Cny Zip Phone <br />, <br />Describe Prc posed Work <br />new house — <br />Lot 2 SP 14-93 -- <br />Iyu <br />Project Address (if known) <br />f II In asapplicable• <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the 0 OW <br />Wln9 <br />of street <br />• Property Lines <br />• Outline and dimensions of all existing end <br />• Indicate North <br />structures the lot <br />• Show any proposed grading changes <br />proposed <br />• Existing and proposedd utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All malls for Inspection shall be made 24 hrs. in advance • phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />01 <br />Aovedd Construction ""` <br />AID <br />FIN <br />AL SPECTION _-'_ <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />Ever Ceder Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />ca <br />0 <br />z <br />O <br />N <br />O <br />a <br />The undersigned owner; applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of Installation <br />and majnl nce of the I provement or other righl-of•way use hereto <br />applipol r and to ther a ees to remove same upon notice from the <br />r.ity/a to reviacf publicliraperty Aamaged thereby. <br />SignaNre of APPlicanV <br />WORKAUTHORIZED <br />DATE PERMIT IS ISSUED RMIT MUST BE STARTED WITHIN <br />180DAYS ISSUED AND THEREAFTER 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 />