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+�t J Z"r"��8� PUEI�c Works Permil• '� / <br /> DatB��4 eiae oeoi.• <br /> Applica 'on For <br /> PUBLIC WO�KS PE � ,�p -�� P�bl¢WadaFee <br /> g �p�d�ilNG T�Ie1Fee s <br /> less AoOt Fee P&i0 f <br /> bnce Due S � <br /> PrintorTypeOnly � ggSg � g g g �' ggg �'. • <br /> O � � MM .'� � � � w � � � � M � <br /> M 1 <br /> James A Berg Design 6 CottSt 25 171st P1 �1the11 S3A 98812 742-2702 <br /> Owner Ma� g�A ress � - Y H � � � �,.�� � Phone <br /> � �' � �� � � � � Q � � NQQ � <br /> Owner � S� S� �� m � � •`�+ •�+ •�i � 1S5 <br /> qpplicant Mailing Address City 2ip Phone <br /> Describe Proposed Work new house <br /> Lot 2 SP 34-93 <br /> W <br /> Prolect Address�if known) 11128 3rd Ave SE � <br /> � <br /> Atlach four(4)copies ol plans tor proposed work- Draw to scale and note�he following as applica6le: � <br /> • Properry Lines • Cen�erline ol streel <br /> • Outline and dimensions of all ezisling and • Indicate North <br /> proposed structures on the lot • Show zny proposed gtading changes <br /> • Ezisting and proposed ulilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calis tor inspection shall be made 24 hrs.in advence•phone 259•8810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Slanderds and Specifications. � <br /> 3.Call Locelion Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> � ��� dr'i✓ew� -1� prop_ �lhe -E" �d� ° � �c.s Pl�k I'�, O <br /> , <br /> �n sf�''�� � � <br /> J�, �n s�L-�i�l � S�r"q c�✓�ti,M i"1�,��c.� a'`-fi i1� �/,�-!r c!� L��'12. N <br /> G� � �o-B✓ �� �(2 w ov�r �'� s P c c�n✓r c�l^co�;a,� ,h -�;c (d. O <br /> � ���� 339-7�0¢) a <br /> ACKNOWLEDIiEMENT OF CONDITIONS <br /> The imders�gnetl owner/applicant hereby agrees to hold and save harm� <br /> less the Clly of Everett irom any and all claims for damages, cosis, <br /> eapenses, or causes ot action Ihat may arise because of installation <br /> P��` �Mr// �i��J/�/1 and maintenance ol Ihe improvement or olher righDOFway use hereto <br /> l/I"�-CQ/ / � "I applied for and further agrees to remove same upon notice Irom Ihe <br /> Approi�br Cons uction � Date City and to replace public property damaged thereby. <br /> D' � v-�-� /�=' <br /> `' _ /„/ 6/ S <br /> FINAL INSPECTI P �_ Dale <br /> pppmved as Constiucted Signature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �A�� PUBUCWORKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED ANG THEREAFTER IS TO <br /> 3200CedarStreet BE DILIGENT�Y PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�BB70 PROJECT OVER 90 DAYS DURATION. <br />