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A � � <br />>HN <br />��� <br />p7 <br />��� <br />C+1 O � <br />H <br />OH <br />��g <br />�V � <br />H <br />zH <br />�H 7 <br />g� <br />C'] C7 � <br />ii � <br />HOtyp <br />Date 7-3-91 _ � <br />Applicat���� For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Oescribo Proposed Work _ SFR adCition, 672 SF <br />r" • <br />- -- _:Y.- <br />w.�.,�.o...�= _ <br />Pubbc Wm�a Per91�Z%ZS% <br />�Itlp. De01. � <br />PubhcWOrkSFle s <br />Tole1 Fee <br />LefsFOP�FeaPa�d S <br />Project Address (d known) ��v w ww <br />AUach lour (41 copies of plans tor proposed work - Draw to scale and nole ihe lollowing as applicable: <br />• Propedy Lines <br />• OuUine and dimensions of all ezisting and <br />proposed structures on the lot <br />• ExisUng and proposed utili�ie5 <br />oaia�ce Dua � <br />353- <br />• Centerline of siree� <br />• Indicate North <br />• Show any p�oposed grading changes <br />• Show measurements <br />Phone <br />I PERMIT CONDITIONS <br />� 1. All calls for inspection shall be made 24 hrs. In advance - phone 259•88i 0. <br />�� , 2. All work shall be pcdormed in accotdance wilh this permit and wrrent City of Everelt Design and Conslruclion <br />1 Standards end Specilications. <br />� 3. Call Location Underground Service 48 hrs.6etore you dig. TOLI FREE NUMBER 1-800•424•5555. <br />��� <br />/-G�c GJa�s F2�'''�"'w/' ��o-T` t�cccti. <% <br />.� <br />/ / /� <br />7_ �-- %� <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />�Ap��PUBLIC WORKS DEPARTMENT <br />32U0 Cedar Sireet <br />Evcretl. WA 98201 <br />Phone: 259-BB70 <br />ACKNOWI.EDGEMENT OF CONDITIONS <br />W <br />H <br />�w <br />�/ <br />� <br />O <br />�w <br />_ I <br />O <br />a <br />The undersigned owner/applicant hereby a9rees to hold and save harm- <br />less ihe City ol Everelt Irom any and all claims lor damages, wsts. <br />expenses, or causes ol action ihat may arise because of installation <br />and mainlenance of ihe improvement or other right�o4way use hercto <br />applied lor and lurther agrees lo remove same upon notice Irom Om <br />City and to replace public properry damaged ihereby. <br />Signalure ol APplicant Datc <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTEO WITHIN <br />BE DI�LIGENTLY PURSUED TOICOMPLE�TION.DTH SEPERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />� <br />