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Date <br />6 7_ze -s <br />PuExc WOMS Permit is <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work _ <br />Project Address (if known) <br />Plan Check No: B 46755 SEPA <br />Applicat.Date: OW8�95 <br />JJob Addrees: 78 2 OVERLY BLVD <br />Owner: GRIEBLER LARRY <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Deec. of Work: <br />CARPORT, STORAGE, 1/2 BATM ADDITION <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />BIft Dept. <br />Punk Works Fee <br />Total F.. 3 <br />Lea Appl. F•• Pit", $ <br />Balance Du• 3 <br />p Phone <br />D Phone <br />Attach four (4) copies of plans for proposed work- Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All tails for Inspection shall be made 24 hrs in advance - phone 259.8810. <br />2. All work shall be performed In accordance with this permlt 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 />PUBLIC WORKS PERMIT <br />NOY REOUIREP <br />DATE. s <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cadar Street <br />Everett WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />im <br />O <br />n <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages. costs. <br />expenses. or causes of action that may arise because of Installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />