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'.%Applicalion For <br />� PUBLIC WORKS PERMIT <br />� 1 6 ��UBLIC V�/ORKS DEPARTMENT <br />3�0 Cedar Sireet <br />T!� ? 0 ST I N G�---�EOerett, �(/A 98201 259-BB10 <br />�i c� O o f� [� o <br />y� O cJ ft ll'1 O Cl O O Unl <br />TYPE OR PRINT ONLY �,`_ o: ..i ci -o ci ci o ri � <br />�.; � c�.i r�i «. cd in t- m c,i <br />n. PN e> ai M �� W� 0� <br />BERG MINNIE 12417 36TH �VE SE El�$tET!� 98248 <br />Owner Mailing Addr '� r< <? � � Ciry�� <br />TOM BERG <br />Describe Proposed Work <br />337-0145 <br />PROJECT ADDRESS (if krown) <br />NGW DUPLEX <br />5113"S 3RD AVE <br />Date 12/12/96 <br />Public Works Permit # 1� V � 7' <br />Building Permit M S37S0 <br />/J � <br />Public Works Fee $ /� <br />- �'S40 <br />�ne <br />PLAT <br />Attach four (4) coples of plans for proposed work - Draw lo scale antl note the following if applicable: <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br />•Centedine o( street •Indicate Norih •Sho� any proposed grading chang� s •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service �'t� hrs. tsfore you dig. T�LL FREE h_.MBE� i•CGJ-A2d-5:55. <br />� <br />•, , f���� <br />lhi ��s�.��i u•c� Q s��aCt oZ crn��u t� <br />�. W,��� �.��2 ��".� J-!C�'4� <br />�OQ � <br />G�. T'��4�C,6l�G'7-`LtifC��S 7G'�� /IdOT• �C/ dOG✓n S�DOtJf'S. <br />7��G�z�w�� ��'ar"S �� aLlowc� �/i� f�x c<<Ccc� �0l�.�- <br />. <br />�� �� � � � %% <br />Approveil or s�t/ tJ�� Date <br />r/ GJw -'—� //—/ / <br />FINAL NSPECTION Date <br />Approved as Constmcted <br />/ <br />W <br />� <br />���/� <br />V♦ <br />� <br />O <br />� <br />� <br />O <br />�♦A <br />V♦ <br />0 <br />a <br />ACKNGWLEDGEMENT OF CONDITIONS <br />The undersigned owner�applicant hemby agrees to hold and save hartnless <br />ihe City of Everelt from any and all claims lor damages, wsts, expenses, or <br />causes of action thal may arise he• ��se of instaiiation and malntenance of <br />Iheimprovementorotherright-of-� ,aheretoappliedforandlurtheragrees <br />to remove same upon notice frc � City and to replace public property <br />dama9edlhereby. <br />'� � <br />��j�_�.�.r�"' . <br />Signafure of Applic nt Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 L 4Y5 OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGLN7LY PURSUED TO <br />COMFLETION. THIS PEFMIT MAY BE CANCEILED 6Y THE CITY UPON ANY STOPPAGE OF N'OPK ON THIS PFOJECT OVER 90 D4YS DUFiATION. <br />