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Date <br />-. <br />ApUlication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />^� <br />Pubbr. lVorkn Permit • A c <br />IB�dq DeM.. �� O 7/ S� <br />Funhc IYorks Fec <br />iotTl Fpe 5 <br />Ll'S5 40UI. FCe �pi� ..S <br />Balance �uo $ <br />Plan Check No: C 48795 SEPA <br />Appllcat.Date: 06/28/95 <br />Job Addrs: 1802 DULL PLACE <br />O.vner TOwan�t HENRY JACK � <br />n <br />Propoeed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Work: <br />Applicant ZN7 STORY ADDITZON <br />Describe Proposed Work <br />Zip <br />OFFICE SET .708 SET <br />APPRVD FOR PERMIT: DATE_/_�_ gy ,_ <br />Pro�ect Address �il known! LB�� _� �%ULL _rPL9� <br />Attaeh four 14) coPies ot Ulans ;or propose,l wo:•�. � pi,�r: t� .; .ii.• .c..,� i��:ti, Ih�t !011owinq �y apU6r.ahl�+: <br />• Properry Lines • Centerlinn o1 street <br />• Outline and dlmensions of all exiyting and • Indicab: <br />proposed siruCtures on Ihe tot NO1��� <br />• Existino and proposed utilities ����"�' i°�Y `«�osed gradin� chanyp5 <br />• Shnw measurements <br />Phonc <br />Phon<� <br />�-� �•�+� �•�ii� otLVW IHIS LWE � <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be peAormed in acwrdance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•$00-QQ4•5555. <br />�UBLIG WORKs PERMIT <br />h0? EaWAEO <br />%Y <br />r�ATE 7 ZS'�S <br />___ _. ___ .__ _— _i <br />i <br />I <br />Approved for Construction - � <br />Date <br />FINAL INSPECTION Datc <br />Approved as Constructed <br />����e� PUBLICWORKSDEPARTMENT <br />3200 Cedar Street <br />Everett WA 98201 <br />Phone:259�8870 <br />.1CKNOWLEDGEAIENT OF CONDITIONS <br />� <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />v/ <br />O <br />a <br />ih�. ��•�h,,;.,.����,� ��•:��evaPplicant hereby a9ree5 to hold ancl save harrn� <br />Irsti ;li�, Cdp or Lveret� from any and all claims for c7amaqes. cosis. <br />expenses. or causes of action that may anse because of mstallation <br />and maintenanr.e of the improvement or other righl�ohway usc he�eto <br />�;=i���^;' �^r anri furihe�r aqrees to iemove samo upon notice I.om Ihe <br />C.�.. .�tq In ii�Pl.iC�r I:ubliC ProPaliY danlaged thcrebY_ <br />� $iq�ld�uic Ot APpbC3i1! D��C <br />I IYORK AUiI{pqIZED BY THIS PERMIT MUST 8E STARTED WITHIN <br />I�90 C.4YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLI' PURSUED TO COMPLETION. THIS PER�dIT tdAY BE <br />' C:.NCELLED BY THE CITY UPON ANY STOPPAGE OF lkpFK ON THIS <br />j PROJEG7 OVER 90 DAl'S DURATION. <br />