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Date_�=24 TQ POSTI11l� ""'�� i PO�IicWorksParmii• � DI / <br /> Application For em9 oeci.• 4���� <br /> PUBLIC WORKS�:PERMIT PubbcWorksFee <br /> �; Totel Fee S <br /> CT. <br /> � less AppL Fee Peitl S <br /> �� Belance Dua S ��' <br /> Print or Type Only � �; �j � � ,-�r, � �� �; � � <br /> r� r-� <br /> o -aoioo + r..� N vi o � t� / � %- � <br /> in c, r� a� �i � �;,� r; o t� n� ra .3l0 l� - � /��}/ <br /> n 1 n> ' �w�� w ia .�+ — ��- <br /> Rollin Carlson 21117 59th Ave NE' Aa�fnston WA 9822� �r'. "� � <br /> Owner Maiting Atlddess, r•, -_ ��Cityr iu-�p. >Zip PI-�one <br /> � �+- � o-. c� o n: r� s; i,i •� <br /> o, c:� r� �� .x x co o �.i o � c� i5 <br /> Cd or'1 iut� � U r, .-::: UI- 03 u) t4l <br /> DeMaris Const Chuck Detdaris 483ii87Fr.I c; b' � �o' ui n n:' � `i .-.�4�. ui in �r <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work new house <br /> Lot 41 Queen Anne Addn <br /> Pro�ect Address(if known) `�l9a0AW�� EdQO� � <br /> Attach lour(4) copies oi plans br prcoosed wcrk- Draw to scale and note ihe lollowin�as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all exising and • Indicate North <br /> proposed stn�.iures on the lot • Show any proposed gratling changes <br /> • Existing and p �posed utilities • Show measurements � <br /> DO NOT WRITE BELOW TH�S �INE <br /> P'cRM1T CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be performec in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 4B lirs.befoie you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> . � <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereCy agrees to hold antl savo harm� <br /> less the Gry of Everetl irom any and all claims for damages, costs, <br /> ��� ���� �_ / �`�/� expenses, or causes of action that may arise because ol installation <br /> and maintenance of ihe improvement or other righFobway use hereto <br /> applied r and further agrees to remove same upon nolice irom the <br /> Approvetl lor Construction Date Ciry� d replace public prnperry damaged thereby. <br /> U/or��i0�,o�e�e — �� �s-5� G _z�r r�� <br /> F eDlAW- � 1 Date ` <br /> H J"�K `�`�^ I o " Signature I Applicant Date <br /> ���I�� SE?u-fi Vtoo Ic�� WORK A HORIZED BY iHIS PERMIT MUST BE STARTED WITHIN <br /> PUBLICWORKSDEPARTMENT 180 �AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLE710N. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY ST OPPA G E OF W O RK O N T H I S <br /> Phone:259•8810 <br /> PROJECT OVER 90 DAYS DURATION. <br />