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.��_�..•. . _—____ _�....��:a.--- I _ <br /> � Pu�lic Work�Permil• <br /> Date <br /> eiay.oeo��• <br /> Application For <br /> PUBLIC WORKS P�RMIT PUbToalFeaFae $ <br /> lesa pp0�Fee PaiE $ <br /> Balanca Due $ <br /> Print or Type Only <br /> Plan Check No: B 43650 SEPA <br /> Applicat.Date: 03/O1/94 Phone <br /> Job Address: 1111 LOMBARD AVE p <br /> Owner Owner: ANDERSEN RAYMOND ' <br /> Tenant: <br /> Proposed Use: GARAGE <br /> Desc. of Work: iP Phone <br /> ppplicant DETACHED GARAGE . <br /> OFFICE SET JOB SET <br /> Describe Proposed Work _ <br /> APPROVED FOR PERMIT: DATE_/_/_ BY <br /> W <br /> Proiect Address(if known) � <br /> Altach lour(4) copies of plans for proposed work• Draw to scale and note the tollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and d�mensions of ail existing and e Indicate North <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements /� <br /> W <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspectlon shall be made 24 hrs.in advance� phone 259•881 O. <br /> 2.All work shall be perfo�med in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specitfcations. � <br /> 3.Cali Location Under�round Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500•424•5555. <br /> O <br /> PUBLIC WORKS PERANIT � <br /> NOT REDUIRED <br /> BY -3/'9/!� SL _ Y/ <br /> �ATE �+B O <br /> a <br /> ACKNOWLEDGEMENT OF COPIDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everell (rorr� any and all claims for damages, costs, <br /> expenses, or causes uf aclion that may arise because of installation <br /> � and maintenance ot the improvemenl or other right•of-way use herei:� <br /> applied (or and furiher agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Dale Dale <br /> Approved as Constructed SignaWre ol Applicant <br /> �� WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �A�IV PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Streel BE DILIGENTLY PURSUED TO COMPLE710N.THIS PERMIT MAY 8E <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PRf�JFCT(1VFR 9(1 DAYS DI IRATION. <br />