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ae 7-11-85 Public WorkF Permit• OS <� <br /> Application For 010 Dept.a <br /> PUBLIC WORKS PERMIT PvbicWorks Fee <br /> Fee <br /> Leu APPt Fee Paid a <br /> n OG' <br /> Print or Type Only Balance Due <br /> JAMCO 8227 44th Ave. W. Mukilteo 98275 745-8911 <br /> Owner Mailing Address City Zip Phone <br /> Seattle Construction CO. ;PO Box 867; Woodinville 98072 483-0339 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work Clear & grub 'obsite, build sediment pond, grade building slab <br /> install storm sewer, sanitary sewer, 8" water main to hydrant, tri 1120 to <br /> building, footing excavation, remove ext'g. sidewalk & curb, install new <br /> _driveway entrance & walkway UJ <br /> Project Address(if known) / S Wilt <br /> Attach lour(4) copies of plans for proposed work-Draw to scale and note the following as applicable: <br /> • Property Lines • Centerline of street /w <br /> • Outline and dimensions of all existing and • Indicate North V, <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made :4 bra. in advance- phone 259-8815. 0 <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 his,before you dig.TOLL FREE NUMBER 1.800.424.5555. <br /> ✓�. �/PPC/CQ.✓T <-1�/CL �.c�0/�i.1�E- �SFMG�.tlT- F�� <br /> Cl) <br /> on <br /> ACKNOWLEDGEMENT OF CONDITIONS <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 maintenance of the improvement or other right-of-way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved for Cons t uu�cti000n atttee City and to r ac/e/p licc propertydamagedthereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed 810hature o Applicant Date <br /> evereh PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 2598815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />