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ci H <br />Y � N <br />ORO <br />O• M <br />N <br />M <br />H <br />M <br />in <br />N <br />N <br />rA 2 <br />Dates-��� z <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Works Permit <br />Bldg. pool.• ,roc-� / �o <br />Pubtm Works Fee f <br />Total Fee <br />Leas APPL Fee Paid $ <br />Balance Due 9 <br />Plan Check No: C 36216 SEPA <br />Applicat.Date: 04/02/92 <br />Owner Job Addrs: 3434 FEDERAL AVE Phone <br />Owner: OVERSVEE, JOHN <br />Tenant: <br />Pr,osed Use: SINGLE FAMILY RESIDENCE <br />of Work: <br />Applicant rION Phone <br />Describe Proposed Work OFFICE SET JOB SET <br />APPRVD FOR PERMIT: DATE_/_/_ BY <br />WWI <br />Project Address (if known) A <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street ♦A <br />• Outline and dimensions of all existing and • Indicate North v+ <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements M <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 performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NJMBER 1-800.424.5555. <br />O <br />i L/✓yG� t G✓CrZ�'� �rei7n�..r� / L�� �y�ccai-=�C/i <br />a <br />Construction <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />OLPUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses. or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same 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 THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />