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5 3�-z�-d- � ' <br />qpp�a,tlion Far <br />� PUBLIC WORKS PERMIT <br />� PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />c� Everetl, WA 98201 259-8810 <br />� r� g g u� � g o�� <br />oete 4-4-96 <br />F•iblicWorksPermitll ����`� - <br />Building Permit q 513 <br />Public Works Fee $ vv ' — <br />TYPE OR PRINT ONLY � 1!1 � �p� M N � N:: m <br />;� �AM N � M �OIN!''1 <br />Van Der Leer/D�$t1" Monica daKe 49'2?' 164th St SI�PtG306 I <br />Owner aNin ddress t' � o City <br />a ���+�� � ��� � � <br />Ken Mattso a ziP <br />ailing Address City <br />Applicant .' }� ST I N G <br />Describe Proposed Work <br />new house <br />98037 745-5656 <br />Phone <br />OCT 0 8 � <br />PROJECT ADDRESS (if known) 47J ""a•• " <br />Ariach tour (41 copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•property L1nes `Outline and dimensions of all existing and proposed structures on the lot 'Existing and proposed ulilities <br />'Centerline of street •Indicate NoAh •Show any proposed grading changes •Show measurements <br />� <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All wc�rk shall be ;,erformed in accordance with this permit and current City of Everett Design and <br />Construci�on Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555• <br />�vr� o��� -� rl �r� c� rc. � sy s�.e �n `. �.) rh <br />�, D�Schr� c �vv�� �P <br />� �( ,l�s�ecfwG'33t-7Ya3P, iG,--fo Co�+ncc¢�uy. <br />�GZG� vt 6�� . �a / <br />$, s.���.� �5 � s�a P��,, #�r. <br />�ll� ✓e V"a�1 <br />� <br />O <br />V♦ <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the Ciry ef Everett from any and all claims 1or damages, costs, ezpenses, or <br />causes of action that may arise because of installation and mainlenance of <br />the improvement or other right-of-way use hereto applied for and furiher agrees <br />to remove same upon notice from the City and to replace public property <br />damagedthereby. <br />� ' � Ya r'�!i4-� • 6 /d -%6 <br />� � O <br />ignalure of Applicanl <br />Date <br />OMPLEf10N.RT}iIS PERMIT MA YBE CANCEBLED BY TH�E CITYIUPON ANY SOTOPPAGE OF WORK OSN THIS PROJECT CVER 90 DA SEDUILRATION.Y PURSUED TO <br />