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�'a�Q � PuGLc Wods Permit• <br /> Appliwtion For BIEq.Depl.t <br /> PUBLIC WORKS PERMIT Pubi�cWorkaFee <br /> Totsl Fee S <br /> Less ApO�Fae PaiO S <br /> Print or Type Only Plan Check No: B 45528 SEPA eeianceoue S <br /> Applicat.Date: 09/12/94 <br /> Job Addrs: 710 EDWARD AVE <br /> Owner: PET20LD HORST W SR <br /> Tenant: <br /> Proposed Use: SINGLE FAMILY RESIDENCE <br /> Owner Deec. of Work: Zip Phone <br /> ADDITION, TWO STORY <br /> Applicant OFFICE SET JOB SET ZiP Phone <br /> APPRVD FOR PEAMIT: DATE_/_/_ BY <br /> Describe Proposed Work <br /> _ W <br /> Prolect Address(if known) _ � <br /> Attach tour(4) copies of plans tor proposed work• Draw to scale and nole the following as applicable: � <br /> • Property Lines • Centerline of stre=t � <br /> • Outline and dimensions ol all existing and � Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT COND�TIONS <br /> 7.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with it�is permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Ca�l Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500-424•5555. � <br /> O <br /> 'UBLIC 1,vORKS PERMIT � <br /> NOi REOUIREfi � <br /> �Y O�nTe 9 i7 y'� <br /> a <br /> ACKNOWLEDGEMENT OF CONOITIONS <br /> The uidersiqned owner/applicant hereby agrees to hold and save harm- <br /> — less tha Gity of Everett Irom any and all c�aims for damages, costs. <br /> ezpenses, or causes of action that may arise because of installation <br /> and maintenance of the improvement or other righl-of-way use herelo <br /> applied tor and furlher agrees to remove same upon notice irom the <br /> Approved for Construclion Date Ciry and lo replace public properry damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Dale <br /> /A���� PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarSlreel 180 DAYS OF DATE PERIv�1T IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259�8010 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS OURATION. <br />