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� _�. �� <br /> � (] H� � PubLc\Yorka Peimil• � <br /> r <br /> Date—fi�l[ll/-9 36991 <br /> G � � 1 2 eleQ Dept� -- <br /> App�ication For <br /> � y PUBLIC WORKS PERMIT P°"","°,""° S <br /> � � s rmr�Fca <br /> N Less RoOI Fea Pm� $ <br /> O C! O 0amnco Due S - <br /> � N N <br /> � Print or Type Only <br /> �a <br /> .� <br /> 1501 Fulton Everett 98201 252-0700 <br /> Mf�1 DaVid Simpson Z�p Phone <br /> � ;b Mailin9 Address C��Y <br /> �„i Owner <br /> M <br /> H — <br /> N RC'nalSsanCe ld Ci�Y Zip Phone <br /> p � y ApP���a�� Mailing Address <br /> R <br /> � � rm � Bedroom & bath addition on SFR <br /> y y Describe Proposed Work <br /> O <br /> W <br /> 1501 Fu�* °"" SE' � <br /> Projecl Address lil known) � <br /> Attach tour(4)copies of Plans lor proposed work� Draw to scale and note�CQo11ew�ne ol stpeyi;able: � <br /> • property Lines • Indicate Norih <br /> • OWline and dimensions ot all eaisting and � ghow any proPosed 9rading changes <br /> proposed sirucWres on Ihe lol � Show measurements M <br /> • Existin9 and proposed utilities W <br /> DO NOT WRITE BELOW THIS LINE O <br /> � ,.. . <br /> ��' PERMIT CONDITIONS �\ <br /> 1.All calls lor inspeclion shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be performed in accordance wilh Ihis permit and currenl City ot Everetl Design and Consiruction � <br /> � �, Slandards and Specifications. � <br /> _ 3.Call Location Under9round Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800•424•5555. <br /> � ' <br /> r� O <br /> I ; <br /> ' ��� �d6�� -� ���� � l� ��=,.w� /oT,�-�«-� �(• � <br /> I -� �b (A <br /> L,-/7- � l O <br /> �� <br /> � -- o. <br /> +'� ' 1 1 ' ACKNOWLEDGLMEN70FCONDITIONS <br /> � ! The undersigneA owneVaPP�icant hereby agrees to hold and save harm- <br /> I less the City ol Everett Irom any and all claims for Jamages. cosls. <br /> � ='= expenses, or causes ol aclion ihat may arise because ot installation <br /> � and maintenance ol Ihc improvement or other righ4obway use hereto <br /> \. ;�pplied lor and furiher agrees lo remove same upon ootice irom the <br /> Approved for Construction <br /> Date City and to replace Puhlic properly damaged Ihereby. <br /> FINAL INSPEC710N ��1e �a1e <br /> SignaWre of Applicant <br /> Approved as Consiructed y�/pRK AUTHORIZED BY 7HI5 PERMIT MUST BE STARTED WITHIN <br /> �,r� PUBLICWORKSDEPARTMENT 180 OAYS OF DATE PERMIT IS ISSUED ANU THEREAFTER IS TO <br /> 3200 Cedar Sireel BE DILIGENTLY PURSUED TO GOMPLETION.THIS PERMIT MAY BE <br /> Everell,W�98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:-59�BB70 PROJ[CT OVER 90 DAYS DURATION. <br />