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-_:..�. �.: , <br /> � � <br /> � � �kation For / I <br /> PUBLIC WORKS PERMIT �e 6/6/97 <br /> PUBLIC WORKS DEPAHTMENT �lic Works permR M rl //I� <br /> s2oo ceda�str� , � W �-7 � <br /> 1A� ' <br /> EverettJ WF�gg�p�I„?�g g---_ �Iding Pertnit# 55'ih? <br /> TO P0� Nb <br /> TYPE OR PRINT ONLY Public Works Fee$ �r <br /> �� g �ggg �ig � $ �+i <br /> MARK ELLIS 4803 FOREST DRVS� �� �'tp�i ��Sg� � <br /> Owner Mailing Address� .-1 Zipa Phone � <br /> T M N �M � N � I <br /> _ � I <br /> Applicant Maiiing Addresso� W � W g �� � � Zip Phone <br /> d d <br /> Describe Proposed Work NEW HOUSE ■ � ■ <br /> W <br /> � <br /> � <br /> � <br /> PROJECT ADDRESS(if known) 4803 FOREST DR � <br /> Attach four(4)copies oi pans for proposed work-Draw to scale e�id r�ote the following if applicable: <br /> •Property Lines 'Outline and dimensions oi all existing and proposed structures on the lot •6cisting and proposed utilities O <br /> •Centerline of street •Indicate North •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2. All work shall be pertormed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> � <br /> O <br /> a <br /> �° <br /> , <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> L � /Z The undersigned owner/applicant hereby agrees to hold and save hartnless <br /> (�/ � the Ciry of Everett trom any and all claims for damages,costs,expenses,or <br /> Ap roved for nstru�•� Date causes of action that may arise because of installatlon and maintenance of <br /> � the improvement or other nght-of-way use hereto app�ied forand turther agrees <br /> to remove same upon notice from the City and to replace public property <br /> —�f d tlamaged thereby. <br /> �NSP ION Data <br /> l,ppmved as Corstructed � ` C <br /> FtI^-- � � D // � <br /> Signa e of Applica Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AN�THEREAfTER IS TO BE OIUGENTLY PUfl5UED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 40 DAYS DURATION. <br />