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�•dte P�EIic Work�Fermlt• <br /> Application For eiav�oeoi• <br /> PUBLIC WORKS PERMIT °°°To;Feefee s <br /> Less Aoo�Fee PsiE S <br /> BaienceDue S <br /> Print or Type Only Plan check No: s a3951 SEPA <br /> Applicat.Date: 03�30/94 <br /> Job Addreee: 21 8 BROADWAY <br /> owner: RUTH WES <br /> Tenant: <br /> Proposed Use: SIIiGLE FAMILY RESIDENCE — <br /> Owner Deac. of Work: Zip Phone <br /> FOUNDATION REPAIR <br /> Applicant OFFICE SET JOB SET Zip Pnone � � <br /> APPROVED FOR PERMIT: DATE_/_/^ BY ' <br /> Describe Proposed Work <br /> W <br /> Project Address(if known) � <br /> Attach four(4) copies ol plans for proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the�ot • Show any proposed grading changes <br /> • Existing and proposed utili�ies • Show measurements /M <br /> W <br /> DO NOT WRITE BELOW THIS LIN[ � <br /> PERMIT CONDITIONS <br /> 1.AII calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with ihis p?rmit and currenl City of Everett Design and Constructlon <br /> Standards and Specifications. <br /> 3.Call Locaticn Unde�ground Service 48 hrs.befor.�you dig.TOLL FREE NUMBER 1-F�OQ•424•5555. � <br /> O <br /> � <br /> � <br /> F'UBLIC WOHKS PERMIT O <br /> NOT REOUIREO <br /> BY a <br /> DA �E � 1��' <br /> ACKNOWLEDGEMENT OF COi IDITIONS <br /> The undersigned owner/aNplicant hereby agrees to hold and save harm- <br /> - - -� - less the City ot Everell Irom any and all claims tor tlamages, costs, <br /> expenses, or causes of action that may arise because ot installation <br /> and maintenance of Ihe improvemenl or olher right-ol-way use hereto <br /> applied for and lurther agrees to remove same upon notice irom ihe <br /> Approved lor Construction �a�e City and to replace public properry damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature of Applicant Date <br /> ��r� WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLIC WORKS DEPARTMENT 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarSireet �E DILIGENTLY 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�8810 PROJECT OVER 90 DAYS DUFATION. <br />