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� PUBLIC N{�JRKS PERMIT <br /> Oate�_ <br /> PUBLIC WORKS DEPARTMENT Public Nbrks Pertnit M <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8810 <br /> Building Permit I <br /> TYPE OR PRINT ONLY Publit Works Fee S <br /> _ Plan Check Noe C 56773 <br /> Owner � Appllcat.Detes 10/14/97 SEPA phona <br /> Job Addres 240Y C�.EVELAND AVE <br /> Owners HENSON RAl10NA <br /> Tenanta <br /> App�icant � Deecp�ofdWorkj SINCLE FAyILY RESIDENCE PM1�ne <br /> ERTEND E%ISTSNG BATHROpM 2• <br /> Describe Proposed Work _ � <br /> OFFICE SET�—JOB SET <br /> APPRVD FOR PERHITr DATE � <br /> __��/_� BY — <br /> PROJECT ADDRESS(if known) � <br /> Attach lou�(4)coples ol plans lor proposed work-Draw to scale entl nota ihe Ioliowing If epplicable: � <br /> •Properly Lines 'Outllne and tllmenslons of ali exlsting entl proposed stmctures on the lot •Existing end proposed utilitles O <br /> 'Centerline of slreet �Indicete North •Show eny proposed grading chengas �Shaw measuraments <br /> DO NOT WRITE BEL01N THIS LINE � <br /> PERMIT CONDITIONS: � <br /> 1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br /> 2. All work shall be peAormed In accordance with this permit and current City of Everett Design and O <br /> Constructlon Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-65b5. � <br /> }ur�i� ��t�Kny �ew�Ill � <br /> NUr :t.u�H�:� O <br /> !'I._._.._ <br /> .�r� ._.---�b���T� a <br /> ACKNOWLEDGEMENT UF CONDITIONS <br /> The undersigned owne�/epplicant hereby egrees to hold and save harmlesa <br /> the City ol Eve�ett from any and all clalms for demages,costs,expenses,ot <br /> Approved lor Construction Date causes ol ectlon ihat may arisa becausa of Insta�lation and maintanance ol <br /> tha Iniprovement or other right-of�way use hereto epplled lor end lurther egrees <br /> - to remova same upon notice Irom the City and to replace public property <br /> damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed <br /> Signature of Applicant Deta <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTE�WITHIN 100 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEq IS TO BE DIl16ENilV PURSUED TO <br /> COMPLETION.THIS PERMIT MAV BE CANCEILED BV iHE CITY UPON ANY STOPPAGE OF WORK ON THIS PRQIECT OVER 90 DAYS DURATION. <br />