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x �'i1 <br />Ct� �H <br />Q H <br />a Hx cn <br />H z� <br />k c� <br />O SO <br />y t�i� H <br />Ci7 J � <br />ON <br />�/��g <br />y� V �C] <br />7.NS <br />'��z <br />HH <br />g `� <br />�d� <br />��� <br />2 H f/� <br />H O f/� <br />Date <br />� � LB�� <br />�..,� <br />Application For <br />F�UBL.IC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: B 39791 SEPA <br />Applicat.Date: 03/OS/93 <br />Job Addrs: 2223 FIRLAND PLACE <br />Owner Owner: WOODHOUSE 7EFF <br />Tenant: <br />Proposed Ose: CARPORT <br />Desc. of Work: <br />Applicant CARPORT <br />Pu�lic Works Pcrmil + <br />emo� o�oi. + — <br />Pubbc WJ�k9 Fee $ <br />Tolal Fee <br />�esa ApO� Fee PaiE $ <br />Balance Oue g <br />�;p Phone <br />�ip Phone " <br />OFFICE SE'I JOB SET�_ <br />Describe Proposed Work _ <br />APPRVD FOR PERMIT: DATE_/_I__ BY – <br />Projecl Address (if known) - <br />I 4 � s ol Plans lor proposed work - Draw lo scaie and note �hc followiny as applicable: <br />_ - - _ . Attach our ( ) copie <br />• Properly Lines <br />• Outline and dimensions ol all existing and <br />� prOpoSed StfuCluf@5 on the �OI <br />• Existing and proposed utililies <br />i <br />• Centedine ol street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance � phone 259•8810. <br />2. All work shall be pedormed in accordance with this permil and current City of Everell Design and Construction <br />Standards and Specilicationa <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800'424•5555. <br />�'UBLIC WORKS PERMIT <br />N�EQUIRED <br />BY n <br />DATE � � �� ' <br />Approved lor Constructian Date <br />FINAL INSPECTION Datc <br />Appwved as Constructed <br />��II�� PUBLICWORKSDEPARTMENT <br />3200 Cedar Street <br />EveretL WA 98201 <br />Phone:�59�8870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />N <br />� <br />O <br />� <br />N <br />O <br />a <br />The undersiqned owner/apPlicant hereby agrees to hold and save harm• <br />Iess the City ol Everetl Irom any and all claims For damages, costs, <br />expenses, or causes of action Ihat may arise because of inslallation <br />antl maintenance ot the improvement or olher right-of�way use hereto <br />applied lor and lurther agrees lo remove same upon notice trom the <br />Ciry and to rep'ace public properry damaged thereby. <br />Signature oi ApPlicanl Date <br />WOFK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS Of DATE PERMIT IS ISSUED ANU THEREAFTER IS �TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 6E <br />CANCELLED E3Y THE CITY UPON ANY STOPPAGE OF WORK ON TH�S <br />PROJECT OVER 90 DAYS DURATION. <br />