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Date <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applican� <br />Describe Proposed Work <br />Proieat Address (if known) <br />Plen Check No: C 38174 SEPA <br />Applicat.Date: 09/28�92 <br />Job Addreee: 3315 EDERAL AVE <br />Owners MCLAUGHLIN DONALD E <br />Tenants <br />Propoeed Uee: SINGLE FAMILY RESIDENCE <br />Deec. of Works <br />TWO STORY ADDN <br />OFFICE SET JOB SET� <br />APPROVED FOR PERHIT: DATE_/_/ <br />BY <br />�i <br />PuELc Wod� Pomit • <br />em�. oeo�� • <br />PuOtic Wark� Fea s <br />TotN Fee <br />Le�� Apo� Fee P�iE S <br />B�lence Dua S <br />Phone <br />Zip Phone <br />Attach tour (4) copies of plans tor proposed work • Draw to scale and note the lollowing as ap0licable: <br />• Property Lines • Centerline of street <br />� Outline and dimensions ol ell existing and • Indicete North <br />proposed structures on ihe lot • Show any proposed gradinq changes <br />• Existing and proposed ulilities • Show measurements <br />PERMIT CONDITIONS <br />t. All cells far inspection shall be mede 24 hrs. in advance - phone 259�881 O. <br />2. All work :hall be performed in accordance with this permit and curcent City of Everett Design end Construction <br />Standards and Specificationa <br />3. Call Location Underground Servia3 48 hrs. b��fore you dig. TOLL FREE NUMBER 1•800-4245555. <br />/' v S�, c� �./n ����r...:.F /L/d� <br />Approved for Construction Da1e <br />FINAL INSPECTION Date <br />Approved as Constructed <br />�A�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Streel <br />Everet; WA 98201 <br />Phone: 259•8810 <br />,��,��/ <br />�/l, �. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />�"' <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold end save harm- <br />less the Cfly of Everett irom any anC atl claims tor demages, costa <br />expenses, or causes of action that may arise because of Installation <br />and maintenance of lhe improvement or other ri�ht-of•wey use hereto <br />applied for and lurther agrees to remove seme upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEfl IS �TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUFATION. <br />