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� � � Date B—Z—yl � � Pu�l¢Wo�b Pe�m�l• <br /> 'n oie�oea�.• 91/27458 <br /> p y Application For <br /> � N PUBLIC WORKS PERMIT �°°�o,aFee�co g <br /> y �' H Lece AOV�Fee Pmd 5 <br /> K' (� <br /> Beiance Ouo $ <br /> ro � ro Print or Type Only <br /> N M <br /> M � <br /> p � J. Curtis Sorensen 1012 Edward Ave Everett 98201 252-0328 <br /> � Owner Mailing Atldress City Zip Phone <br /> � � <br /> y y �WIIeT <br /> 'L M <br /> r �y y Applicant Mailing Adtlress City Zip Phone <br /> N <br /> C N <br /> � � � Describo Proposed Work Add 1 Uedroom� exnand livinq room 408 SF <br /> O y <br /> N <br /> W <br /> Proiect Address�if known� 1012 EdwaYd AVe � <br /> Attach fow(4)copies ol plans lor proposed work• Draw to scale antl note ihe lollowing as applicablc: � <br /> • Properry Lines • Centedine of street ♦^ <br /> • Outline and dimensions ol all ezis�ing and • Indicate North V� <br /> proposed siructures on Ihe lot • Show any proposed grading changes <br /> O Existing and proposed utilities • Show measuremenis �A <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> ���� ���.` PERMIT CONDITIONS <br /> � ��^ 1.All calls for inspection shall b made 24 hrs.in advance•phone 259•8810. ^ <br /> 2.All work shall 6e pedormed in accordance with ihis permit and currenl City ol Everett Design and Consiruction ♦ <br /> . Standards and Specilications. <br /> � 3.Call Location Underground Service 48 lirs.belore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> I f�' <br /> � O <br /> N a �u b l� �,�lc�v� l�4 �e,�-t�� ���• �' <br /> ' �� <br /> � ���� � <br /> �� �j_�o_9 � 0 <br /> i �. <br /> ' I <br /> i s1�' � ACKNOWLEDG[AfENTOFCONDITIONS <br /> � The undersigned owner/applic;�nt herehy a9rees to hold ind save harm- <br /> less the Clly ol Everett irom any and all claims br damages, costs. <br /> expenses, or causes ol action lhat may arise because of installation <br /> i�� and maiMenance of the improvement or other ri�ht�ol-way use hereto <br /> applicA �or and �urihr.r a9mes �o remove same upon no�ice Irom Ihr. <br /> - Approved for Construclion Dale City and to iepinr.e public properly dama�ed therehy. <br /> FINAL INSPECTION Date <br /> Approved as CanSiruc�ed Siynalure ot ApPlicant Date <br /> �� PUBLICWORKSDEPARTMENT WORK AUTIIORIZED BY TfiIS PERMIT MUST BE STARTED WIThiIN <br /> , _ R 3200CedarSlmot 180 DAYS OF DATE PERMIT IS ISSUED AND TH[REAFTER IS TO <br /> ^�i BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> �/�err Evemtl,WA 98201 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8870 PROJECT OVER 90 DAVS DURATION. <br />