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i <br /> (� PUEbc Work�Perm�t• <br /> Date <br /> eieo.oen��• <br /> Applicetion For <br /> PUBLIC WORKS PERMIT PuelicWortaFee <br /> TofalFee s <br /> less ApD�Fee PeiE S <br /> Balance Oue S <br /> Print or Type Only <br /> Plan Check No: 8 37165 SEPA <br /> Applicat.Date: 06/26/92 <br /> Job Addrese: 5324 COLLEGE WAY <br />� OW�e Owner: JODOCK, JIM Zip Phone <br /> Tenant: <br /> Propoeed Uee: GARAGE <br /> Deec. of Work: <br /> GARAGE ADDITION Z�P phone <br /> Applicant <br /> OFFICE SET JOB SET <br /> Describe Proposed Worl AppROVED FOR PERMIT: DATE_/_/_ HY <br /> W <br /> Prolect Address(il known) � <br /> Attach four(4)copies ol plans for proposed work- Draw to scale and note ihe lollowing as applicable: � <br /> � • Proper�y Lines • Cenlerline ol streei � <br /> • Outline and dimensions ol ull e,cisting and • Indicate Norih <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> IDO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be mede 24 hrs.in advance•phone 259•881 O. � <br /> 2.All work shall be pertormed in accordence with this permit and wrrent City ol Everett Design and Consiruction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service�48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> O <br /> �_ <br /> �'4� _ � � ' . . -. ' . ' . ."� . _ . � , � � <br /> �;' ✓ (!� <br /> � . O <br /> a <br /> �� <br /> �_ ACKNOWLEDGEMENT OF CONDITIONS <br /> -�� <br /> �� The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe Cily of Everett Irom any and all claims lor dameges, costs, <br /> ezpenses, or causes of action thal may arise because ol installation <br /> and maintenance of ihe improvement or other right�of-way use hereto <br /> appGed for and further agrees lo remove same upon notice Irom the <br /> Approved for Consiruclion Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION �a�e Dale <br /> Approved as Conslructed Signalure of Applicanl <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �I�ii� PUBLIC WORKS DEPARTNENT 780 DAYS OF DATE PERMIT IS I:iSUED AND THEREAFTER IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERP.IIT MAV BE <br /> o Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE Of WORK ON THIS <br /> P'�one:259-8810 PRf1,IFl:T VFR 90 DAVS f7UFRTION. <br />