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D�t�: -- <br /> • l Puplie Worka Parmlt/ �-� <br /> Application For Biaaoro�. <br /> PUBLIC WORKS PERMIT P�OIi�WarkaFe� <br /> To�alFea S <br /> Leaa AOG�Fea PaiO S <br /> Print OT Typ• Plan Check No: C 47854 eaUnc.o�. S <br /> Applicat.Date: 03/27/9.ri Pian Check No: C 47855 SEPA <br /> Job Address: 6109 COMMERCIAL AVE APJobCAddDess� 6118�BROADWAY <br /> Owner: THOMAS DARRYL <br /> Tenant: Owner: THOMAS DARRYL <br /> Proposed Use: DUPLEX Tenant: <br /> Owner Desc. of Work: Proposed Use: DUPLEX <br /> FIRE DAMAGE REPAIR Desc. of Work: — <br /> REBUILD ONE UNIT (FIRE DAMAGE) <br /> Applica� OFFICE SET JO8 SET OFFICE SET — <br /> JOB SET <br /> APPROVED FOR PERMIT: DATE_��_�_ APPROVED FOR PERMIT: DATE <br /> Describe ProE —�—�_ BY <br /> Profect Address(ff known) � <br /> Attach four(4)copies of plzns Ior proposed work-Draw to scale and note the lollowing as applicable: � <br /> • PropeAy Lines • Centerline of slreet !w� <br /> • Outline and dimensions of ail existing and • Indicate North � <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shail be made 24 hrs.fn advance•phane 259-$$10. <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction � <br /> Standards and Specificatfons � <br /> 3.Call Locatio�Underground Service 48 hrs before you dfg TOLL FREE NUMBER 1•800-424•5555. <br /> � <br /> O <br /> FUBUC WORKS PEPMIT � <br /> hOP p pU1REP ♦/� <br /> �/! <br /> �Y__ F' O <br /> �_AT=_ .3/���5 ____ .. <br /> � . �--_.._. <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appiicant hereby agrees to hold and save harm- <br /> . less the City of Everetl Irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise becau�e of installation <br /> and maintenance of fhe improvement or olher ri3hFof-way use hereto <br /> Approved lor Conslruction �ate app�ied for and further agrees to remove same upon notice Irom the <br /> City and to rep�ace public property damaged thereby. <br /> FINAL INSPECTION Dale <br /> Approved as Constructed Signature ot Appl(cant Date <br /> ���I�b� PUBLICWORKSOEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS .TO <br /> Everet4 WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PEFMIT MAY BE <br /> Phone:259•8810 CANCELLED BY THE CITY UPON ANY STOPPqGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUFATION. <br />