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Date_LL=1Z qg � J�Z�`'S <br /> Public Works Parmlt e /✓ �(J � <br /> ApplicationFor eia9.oeo�..— 497q1 <br /> PUBLIC WORKS PERMIT PubTotelFeaFee : <br /> / /n - <br /> Print or T <br /> Y��o�1�?STING �J'`* 'cl C LassAoplFeePaia S <br /> '--�.�� e��r�o�o�� S �-- D�__ <br /> .Tames A Berg Construction 125 171st P1 SE Bothell <br /> Owner Mailing Address �i�Y Zi — <br /> p Phone <br /> Owner <br /> Applicant Mailing qdtlress City Zi <br /> P Phone <br /> Describe Proposed Work new house Lot 4 short plat 32-91 <br /> °�aiect Address(if known) — �I I j(}t,-� �1,�� � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North � <br /> P�oposed structures on the lot � Show any proposed grading changes <br /> • Existing an�� proposed utilities • Show measurements <br /> DO N07 WRITE BELOW THIS LINE � <br /> PERMITCONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8$10. <br /> 2.All work shall be pertormed in accordance with ihis 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 /> � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> � ��� ACKNOWLEDGEMENT OF CONDITIONS <br /> ` Th�andersigned owner/applicant hereby agiees to hold and save harm� <br /> //�� less the City of Everett from any and all claims for damages, costs. <br /> ,{ L n/�j/��� expenses, or causes of action that may arise because of installation <br /> L(,(a,� �� �C� NQU �� ��� and maintenance of the improvement or other right-of-way use hereto <br /> Approved orConstruchon Date applied for and furiher ac�rees to remove same upon notice from the <br /> �� City and to replace public property damaged ihereby. <br /> FINAL INSPECTION S Y— '�/�y <br /> Approved as Constructed ate <br /> Signature ol Applicant Date <br /> ���� PUBLIC WORKS DEPARTMENT WORK AUTHORI7ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3�OOCedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT P�1AY BE <br /> Phone:259��810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> I PROJECT OVER 90 DAYS DURATION. <br />