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�� <br /> 1��2/t'' Pebllc Worb Par s �T�f�'"�" <br /> Date � �d/���' <br /> BIaO�Oeot.r <br /> Application For <br /> PUBL�IC WOaKS PERMIT PUOToaIFeaFee � <br /> less A00�-Fee PaiE S <br /> Belente Dua S�Y ��S� <br /> Print or Type Only <br /> f�.lJ%�� <br /> John ::. Schacl: 102H l�fest .aa�:ne Viea: Drivr B:�arett ��20)- <br /> Owner Mailing Address City ZiG Phone <br /> I4orn'� Anderson, Y.��. I�or. Gf; :'.ar��sv'_lle 98700 G59-113_ <br /> Applicant MailingAddress Ciry Zip Phcnc <br /> Describe Proposad Work Construct Building "D'� ^ __ <br /> -- � <br /> Project Address(it known) �02° 'vlest :!�rine View �rivr � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note L'ie following as applicable: �� <br /> p Property Lines • Centerlina ot street � <br /> O Oulline and dimensions ol all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenls p�/� <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PF_RMIT CONDITIONS <br /> 1. All calls for inspection�hall br.made 24 hrs. in sdvance• phone 259•881 5. � <br /> 2. All work shall be performed io accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> <J -"�i � .'. _ ;'! �f� 7 L�� s". / .=.%_ / ,ri,; ,° � <br /> -�.� �, ��.,�� /J,c1 i�D ���' �- . <br /> �='t r .' :. „ �. <br /> � <br /> Yi <br /> � <br /> a <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm- <br /> less the City of Everett trom any and all claims for damages, cos�s, <br /> � expenses, or causes of action that may arise because of installation <br /> i�-�;- ,�": and maintenance of lhe improvement or other right�of-way use hei�ato <br /> C-""�. � �rJL_,1.�-_:� ,�L%,. . `�� <br /> i .r-� l� � applied,�or and fwth¢r agrees/�o remove same upon notice irom the <br /> Approved for Const��iclion '�a1e Ci�y a��id to rep�ace pdbl�pro�erty damaged Ihereby. <br /> Y�f,...- �r li. ��15'=. <br /> `��7 /^ :� <br /> / /i� \ / <br /> l , / �li�. .G�-l� - -� O J - <br /> FINAL INSPECTION Cate ' ' � <br /> hpproved as Constructed Signa ure ol Applicant ale <br /> WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> everett �U�:LICWORKSDEPARTMENT 1g0 DAYS OF DAP= PERMIT IS ISSUED AND THEfiEAFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPFGG OF WORK ON 7HIS <br /> Phone: 259�8815 PROJECT OVER b0 DAYS DURATION. <br />