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� io G`l<� / <br /> Af.P��cation For 7-29-96 <br /> ���� PUBLIC �fVORKS PERMIT °�1e <br /> 9��z ag <br /> PUBLIC WORKS DEPARTMENT Public Works Permit k <br /> 3200 Cedar Street 52421 <br /> F.vereU,WA 98201 259•8810 Building Permil k — <br /> "`? POSTING �" ° "� � <br /> Public Works Fee 5_ � <br /> TYPE OR PRINT ONLY _ <br /> Marko Jukaaovich 4003 Priest Pt Dr NW Marysville 9ZP71 210-86 Phone <br /> Owner <br /> Mailing Address City <br /> pwnei ���Y Z�P Phone <br /> APP�i— �a�-- Mailing Address <br /> Describe Proposed Work new house � <br /> � <br /> �— �/� <br /> V♦ <br /> PROJECT ADDRESS(if':nown) <br /> 3(� I`t �r�da ,dv�e. � <br /> Attach tour;4)copies of plans for proposed work-Oraw lo scaie and note the following if applicable: O <br /> •Pro�xrty Lines `Oulline and dimensions of all existing and proposed structures on the lol •Existing and proposed utilities � <br /> •Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br /> -� DO NOT WRITE BELQW THIS LINE <br /> PERMITCONDITIONS: p3J09/96 SO�1iAM O�JO�ti71,' �' <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810• O <br /> 2.All work shall be performed in accordance with this permit and current City of H0005�Disign and <br /> Construction Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM F�1-8004a6�'O`j • <br /> ^ . �a'I � �C . 9p..50 <br /> ��. Qub��� WorKs I nsp�or' Q �`��i `�"��^ � <br /> 9 9 9 d���i,�',A,j ��,� 0 <br /> +;on mc�';n r� ar�tn <br /> � GDn�"� tl04004043 Q., <br /> s:dG�v�t 1�.. ��`�l tt+�on . 5lATE; 3650.00 <br /> N000:07+B <br /> ScWE('i 570.ni.� <br /> 5"SD=V !'_�96.OJ <br /> i;HEL'f: ='_u9'._ . <br /> �N" ACKNOWLEDGEMENT OF CONDITIONS <br /> /� n The undersigned owner/applicant hereby agrees ro hold and save harmless <br /> .r /__ n �/)/)� /� y� 7/�/_ the Cily of Everett from any and all claims for damages,costs,ezpenses.or <br /> I/ /�/C.J V < (O causes ol action Ihat may arise because ol installation and maintenance of <br /> qppro edfor nstruction� Date theimprovementorothcrright•of-wayuseheretoappliedlorandfurtheragrees <br /> to remove same upon notice (rom the City and to replac= public property <br /> :� • ,.� � �_y� damaged thereby. <br /> L� . ,".-�� ^, <br /> FI ALINSPECTION Date ��� 76 <br /> � <br /> Approved as Constructed Date <br /> Signature of Applicant <br /> COMPLETION RIH S ERMIT MA YBE ANCELLED BYTHE CIlYIUPON ANV S�TO PAGE OF WORK ON TH S PROJEC 0 ER 90 DOAYS DULRATION.Y PURSUED TO <br />