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Date___vo�95 To POSTING i <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Kvernmo Construction 16212 Bothell Wy SE #325 <br />Owner <br />Describe Proposed Work <br />Project Address (if known) <br />Mailing Address <br />O <br />N 07 <br />M � <br />11 Crbek <br />r, O 4. <br />N M <br />Pebl.0 Works Permit <br />Bldg. oePt:-�.�-i�f_ <br />4o Works Fee <br />Total Fee S <br />Less AvP1.�Feee Paid S <br />�1 <br />b 0 10 <br />M M N i <br />C•1 <br />98012 at`j 485 4911 <br />tarry - Z+ r�74 r� � rhnr-.� <br />C.1 M W W=rpp-J�, F'!o0o �3t�J,J [rl W <br />O � _J v SN 07t U]�AU <br />C 11V---_.'rp Phonn <br />house - Basic 1125 <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls 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 />Approved for Construe io <br />-FtML INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Im <br />O <br />z <br />O <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 maintenance of the improvement or other right-of-way use hereto <br />applied or and further agr s remove same upon notice from the <br />City an to replace public far p rty damaged thereby. <br />Signature ofd Applicant <br />U—_jT��' <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS 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 />