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��;"� . ' �. . . . . � . . <br /> 'S <br /> 4 . . . . .,,.�.: <br /> 2/14/86 --� �, � <br /> 5 Da19 v�eik wonu vxmit r � <br /> BIOp.Dapt• 86/16070 ; } <br /> Applicatlon For � <br /> PUDIIC Worlu FN ! <br /> PUBLIC WORKS PERMIT T,,.,F„ : � <br /> �e..�oc�F.e r.a i <br /> Print or Type Only 9d�nae Due t t <br /> Michael Peacock 4809 Forest Drive Everett 98203 259-7083 <br /> Owner MalNng Addreas City Zip Phone � <br /> 8varett Huilders Inc. 5606 Evergreen Way Everett 98203 353-7161 1 <br /> t <br /> � Applkant Malhng Address City Zip Phone <br /> Conatruct 10'x23' Addition <br /> DescNbe propoaed Work <br /> 1 <br /> W ' <br /> Pro1�t Addrese(if known) 4809 Forest D � � <br /> Attech four(4)copba of D�ana(or proposed work•Draw to scale and note the following as applicable: � . <br /> • Property Linea • Centerline of street � . <br /> •Outline and dlmenaiona o(ell exiating and • Indicate NortlS <br /> propoaed structures on the lot • Show any proposed grading chenges <br /> - • Exietlnp and propoaed utilitles • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O . <br /> ,,. PERMITCONDITIONS <br /> � 1. All calls tor inapectlon ahall be mede 24 hrs in advance-phone 259-8815. � �.. <br /> � 2. All work shall be pertormed in acwrdance with this permit and current City of Everetl Design and Construction <br /> Stendarda and Specificatlona <br /> 3. Catl Location Underpround Service 48 hra before you dig.TOiL FNEE NUMBER 1•800-424•5555. � <br /> �/BL.IC- Lvo.P�''S PE�'/�'ii% il/oT �C=qv�.4�� O <br /> � ���86 <br /> � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The und�rsigned owner/applicent hereby agrees to hold and save harm- <br /> less the City of Everett from any and all clei:ns for damagea, costs, <br /> ' ezpenses, or causes of action thet may arise becauae of instellatfon <br /> and maintenance of the improvement or other righbof-way use hereto <br /> ` Approved for Construction Date epplied for and further agrees to remove same upon notice irom the <br /> City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved es Conatructed Sipnature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUS7 BE STAR7ED Wi7HIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretR WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PEIiM1T MAY BE <br /> Phone:259-8815 CANCELL.ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> FROJECT O�lER PO DAYS DURATION. <br />