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D ate �� r�ouc wo.wa Pc,mn� <br /> Applicalion For Biag.Dept• <br /> PUBLIC WORKS PERMIT Pu�l¢WorwsFee - <br /> Totrl�ee 5 <br /> lesi 4001 Fee PaiC S <br /> Print or Type Only ea���«o�� s <br /> Plan Check No: C 49883 SEPA <br /> Appllcat.Date: 10/26�95 <br /> Job Addre: 932 GL NHAVEN DR <br /> Owner: LEITCH JEFFREY <br /> Tenant: <br /> Owner Ptopoeed Uee: SINGLE FAMILY RESIDENCE pha�� <br /> Deec, of Work: <br /> REMODEL� NEW PORCH 6 ROOF <br /> Applicant OFFICE SET JOB SET Phone <br /> APPRVD FOR PERMIT: DATE_/_/_ BY <br /> Describe Proposed Work _ <br /> ------------- --- W <br /> Project Address lif known` � <br /> A�taCh fOUr(4)copie5 of plan5 tur propOsed wu:k � Draw to 5r,��Lr a�n note the !o�lowing as applicab�e: � <br /> • Properfy Lines • Centerline ot street ♦^ <br /> • Outline and dimensions of all ex�sting antl • Indicat�_ Norih V i <br /> proposed slructures on lhe lot • Show any r,roaoseA gratling changr.s <br /> � Existing and proposed ulilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS Q <br /> 1.All calls for inspeclion shall b=made 24 hrs.in adoance•phone 259•8810. �� <br /> 2.All work shall be peAormed 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 NUMBER 1•800•424•5555. � <br /> O <br /> 'UBLIC WORK6 PEl�Ni` ~ <br /> RO! qFpUt�fc�i //► <br /> t Y�� Ni <br /> +ATF. 1D V/��__, � <br /> a <br /> ACKNOWLEDCiE�AENT OF CONDITIONS <br /> The unde�5iqnetl owner/apPhC2nI he�eby agree5 io hold and Save harm� <br /> --� iess tha City o� Everett Irom any and ali claims for tlamages. costs <br /> � exuenses. or causes of action Ihat maq aris� because of insialiatior <br /> j antl m.intenance o! Ihe improvement or other righbobway use heretc <br /> � aCni�n� lor and further agrees to remove same upon nolice from the <br /> Approved lor Construction Date C�ty.�nd to replaca public property damaged thereby. <br /> I <br /> i <br /> � <br /> FINA� INSPECTION � Date <br /> Approved as Constructed Signature oi Applicant Date <br /> � PUBLIC'NORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHi� <br /> ,�� 3200CedarStreet t80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILiGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259•8810 I CANCELLtD BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PRO,IECT OVEF 90 DAYS DURATION. <br />