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, �� <br /> � <br /> > .� <br /> 1_ � <br /> I <br /> Date �//� `� `� ����'Puplc Worxs Permil• , <br /> ema.oea�= ��'n� <br /> � Application For � <br /> � � " PUBLIC WORKS PERMiT PuCiicWo�xaFee S <br /> b TaialFee <br /> p � , less App�Fea PaiA 5 <br /> 9 � q Balance Oue S <br /> c Print or Type Only <br /> � � <br /> Q Plan Check No: B 3:014 SEPA <br /> O� � "�d� Applicat.Date: 03/17/92 <br /> y N Job Addre: 4912 FOREST DR <br /> � S � Owner Owner: PRINCE, CRAIG Zip Phone <br /> Tenant: <br /> � Proposed Uee: STORAGE SHED <br /> C� ►� Desc. of Work: <br /> STORAGE SHED Zip Phone <br /> M • ApPlicant <br /> � N OFFICE SET JOB SET <br /> N Describe Propose� APPRVD FOR PERMIT: DATE_/_/_ $Y <br /> � � � <br /> � y W <br /> Project Address(if known) � <br /> Attach fout(4)copies of plans for proposed work•Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of sireet /A <br /> • Outline and dimensions ot all existing and • Indicate North V� <br /> proposetl structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements /�A <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.AII calls for inspactlon shall be made 24 hrs.in advance-phone 259�8810. � <br /> 2.All work shall be pertormed in accordance with tr,iy permit and current City of Ever•.[Desiyn and Construction <br /> . - �"`�'-� Standards and Spacifications. <br /> 3.Call Locatlon Underground Service 48 hra before you dig.TOLL FREE NUMBEP 1•800-424•5555. ' � <br /> .. .,�'�., . . <br /> i � <br /> ��� � ���rC CG c '✓':'.,. 1 --�.y,i.c �.'i,�<'iT .��' !_CG-`_. �'' <br /> � � � ' �... <br /> ' , ; /; � � <br /> �—�; <br /> �� O <br /> . , a <br /> � <br /> � ,_ <br /> � -- <br /> � � � ACKNOWLEDGEMENTOFCONDITIONS <br /> < � The undersigned awner/applicant hereby ayrees to holtl and save harm• <br /> ���� • � less the City of Everett trom any and all claims for aameges, costs. <br /> expenses, or causes of action that may arise because of instellation <br /> i � and maintenance ol the imOrovement or othar dght•of-way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> ' � . G Approved for Constructlon Date Cily and to replace public propeAy damaged thereby. <br /> �r• <br /> � '. FINAL INSPECTION Date Date <br /> � ApproveC as Constructed SignaWre of Applicant <br /> ' WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED�WITHIN <br /> PUBLICWORKSDEPAfiTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> �� 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> . Phona:259-BB10 PROJECT OVER 90 DAYS DURATION. <br /> Yi:..' <br />