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i <br /> Date 12/16/R3 Publlc�:�rnuF°H3I1�7 i <br /> BitlO.Uept�_-- <br /> Appliwtion For _._ <br /> F�UBLIC WORKS PERMIT '°°°`"°`",`�e � <br /> Total Fee �T O� `—�j— <br /> ����/' Los[,AO�I Fea PaiO S }� •O ��--- <br /> � � � .�"�"^ Balonce Due S_— � — <br /> Print or Type Only �rP"�� .+y� � <br /> Duane Berg 2704 128th Street S.W. Everetf 98?.f14 353-6'l29 <br /> Owner Mailing Address C'�ty Zip ph^"," <br /> Appiicant Mailing Address City Zip Phone <br /> Driveway for Lot 11 <br /> Descri6e Proposed Work — <br /> (Cancel Public Wors Permit 83/264) _ <br /> --- � <br /> Prolect Address(�.. i�.nown) <br /> `� � o �z ay��=�. S. E• � <br /> � <br /> Attach tour(4)copies oi pians<<�r uroposed work• Draw to scale and note lhe follo�ving as applicsble: � <br /> • Property Lines • GeN�rline o�Slre�t <br /> • Outline and dime�.isions of all existing and • I.�dicate North <br /> proposed structur�s on the lot • Snow any proposed gradinp changes <br /> • Exis!ing a�d proG��sed utilities • SI ow meoe�irements M <br /> W <br /> ��'w� DO N0-WRITE BELOW T:iIS LINE � <br /> PERMIT CONDITIONS <br />` t. All calls for inspection shall 6e mnde 2a ���:s. in advance-phone 259•881 5. � <br /> 2. All work shail be pertormetl in accercence with ihis Fermit and curreN City ol Everett Design and Con.•ruction � <br /> Standards and Specifications. �' <br /> 3. Call Location Undergro�nd Service 48 hrs. before you dig.TOLL FREE NUMBFR 1•800•4�24-5555. � � <br /> r-� <br />� � <br /> � y �, <br /> � y F <br /> � � <br /> � � r, <br /> a � E <br /> � <br /> � <br /> � � <br /> � �. <br /> � ' ; ACKNOWLEDGEMENT OF CONDITIGNS �' =� <br /> ti � <br /> . . . � . �I'�, � � �� <br /> . -� � � � �, � �� The undersigned owner/applicant hereby agrees to hold and save harm- F <br /> less the Ciry of Everetl from any and zl! claims tor damages, costs. � 4 <br /> �� ��7 expenses, or �auses of action that may arise beca�se of in&talletion � r; <br /> � �' _ Z l� _�j and maintenance of the improvement or other riah7•obway use hereto y �� <br /> � appli:d-for-and further agrees to remove same upon noti� • from the � F� <br /> oved fcr Construction,, �, , .:-.� De te �� zn d to r p lace pu blic pro perty dama geA tiier�by. �J� <br /> % i /•� � 7 <br /> . , f ����i � /�'� �y r j, � <br /> Date �� <br /> FINAL INSPECTION i Si nawre of Applicant Date � �f: <br /> Approved as COnstructed � <br /> � 1N09K AUTHORIZED BY THIS PERMIT MUST E STARTED W�THIN <br /> � PUBLIC WORKS DEFFRTMENT 180 DAYS OF DpTE PERMIT IS ISSUED AND TFicREAFTER IS TO r <br /> evereti <br /> � 3200 Cedar Slreel BE DILIGENTLY PUFSUED TO CO��IPLETION. THIS PERMIT MAY B ' <br /> Everett,WA 98201 CANCELLED BY THE CITY UP7N ANY STOPPAGE OF WOaK ON THIS � <br /> Phone: 259-8815 pqOJECT OVER 90 DAYS DURATION. <br /> � <br /> r <br /> ..,,;a.:.br <br />