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� y � <br /> late --1�9f9� .;� I - �7� ��J � �77� <br /> Publlt Wo�ks Permil• <br /> Applicat�nFor a�� p05rING / eiao-oeoi..� <br /> PUBLIC WOF�CS PERMIT Pub7oiefeeFee s_ <br /> ¢ <br /> p I Leee ApO�Fee Pa�C S n �� <br /> � G O b G O C� O O P BelenceDue S �-�'/ <br /> Pflnt Of Type Only � in o 0 o in c� � � o � o t� — <br /> u_ <br /> o [� t^.. O O .Y� O `O V) G U'1 f] .�a <br /> C,I [� y� Q� .-i ei CJ M O L� CJ !n N <br /> .- M aR M eR an � M � .� N <br /> David Flake 12 E Nlarily�Ave Everett 5;98�8 �34�-4916 <br /> Owner Ma g�A�dress x s bCtjty�� � � � ,.. Zip Phone <br /> �O fJ Cl C1 S (9 IY 3 " 0 I�I O LLI N � � <br /> cv odo; r_, �n ;? v oF- c � onw <br /> SeIDe � o � _. w � 3 o a o w _ ., T <br /> sca� :�. s iil41 [� 0- yt33KCflm ,. fa <br /> Applicant Mailing Address City Zip � phone <br /> Describe Proposed Work New hou5e <br /> Proiect Address�it known� _�_E Marilvn Ave _ � <br /> - Attach four(4) copies of plans lor proposed work• Draw to scale anC note tne following as applicable: � <br /> • Property Lines • Centerline of sireet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> � p�oposed structures on the lot � Show any proposed grading chenges <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 7.All calls for tnspectbn ahall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be performed in exordence with this permit and current City of Everett Design and Construction <br /> Standards and Speciflcetiona. <br /> 3.Call Lxatlon Underpround Service 48 hrs.before you dig.TOLL FREE NUMBEN 1•800-4245555. � <br /> � <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> OK The undersigned owner/applicant hereby agrees t�hold and save harm- <br /> less the Ciry of Everett irom any and all claims for damages, costs, <br /> � G expenses, or causes of action that m�y arise because of installation <br /> /-2�—� and maintenance of ihe impro ement or other right•of-wey use hereto <br /> � � applie for and furiher agree to r move same upon notice from the <br /> Appr ved for Constru i Date Ci n ro replace public pro rty meg ihereby. <br /> d ,Ja , s S� � <br /> FIN.4L INSPECTION Date <br /> Approved as Constructed Signature oi 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 /> Evarett,WA 98201 BE DILIGFNTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> �� Phone:259-8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />