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2. <br /> Date 8/17/95 Public Works Permit# ✓143 <br /> Application For f<-, ?IN J]g •1 '0 Bldg.Dept.# 49246 <br /> r.., v <br /> PUBLIC WORKS PERMIT RIV T Public Works Fee $ <br /> CZ <br /> Less AppC Fee Paid $ _ <br /> Print or Type Only 88 8 8 ""=glance Due $ <br /> DAVID HUDSON 4710 HARBOR LN EVT 982, 3 el 353--550Cf <br /> Owner Maiiin u''` `, ctC�it ` 0 <br /> g Address at 4i1 p' , Phone <br /> C 3 t.3 I—! � Cl 1.Is <br /> WAYNE SCHARBACH (SCHARBACH CONST) 652--5876 V, 2 c ' <br /> Applicant Mailing Address City Zip Phone <br /> NEW DUPLEX (BASIC 1103) <br /> Describe Proposed Work �r� i ( �( w <br /> Project Address(if known) (�t..•'l.V1J_ i _� f�.~tC��G fim" <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 /> .proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> all <br /> DO NOT WRITE BELOW THIS LINE <br /> 0 PERMIT CONDITIONS <br /> -'r„ 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 /> 0 <br /> I— <br /> Cl) <br /> 0 <br /> am <br /> ACKNOWLEDGEMENT OF CONDITIONS <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 /> 4A-4/1/6 <br /> 4expenses, or causes of action that may arise because of installation <br /> � 7 61S- and maintenance of the Improvement or other right-of-way use hereto <br /> { applied for and further agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace public property d waged thereby. , <br /> /4 ./17 <br /> FINAL INSPECTION • s Date r c c,. '' v <br /> Approved as Constructed 8'Ig ature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY-PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259 8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />