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Date__ �•�w <br /> ,. ,, <br /> P�bl¢1Yorxs Permit Y <br /> Applicelion Far <br /> Bldg.Gept a <br /> P41BLiC WORKS PERMlT PuCI¢WorksFee �' <br /> Totil F¢¢ S <br /> Less ADOL Fae PaiO $_-_ <br /> Print or Type Only e��.,��zo�� 5_ <br /> Plan Check No: B 494i9 <br /> O�vner Applicat.Date: 09/13/95 SEPA Phon�_ <br /> Job Address: 1202 LOMBF.RD AVE <br /> Owner: VAN DEE ROBffiRT <br /> Tena�t: <br /> Applicant P=oposed Uae: CARPORT -- <br /> Desc. of Work: Phone — <br /> NEW CAP,PORT <br /> Describe Proposed Wnrk <br /> OFFICE SET JOB SET <br /> APPROVED FOR PERMIT: DATE_/�� HY — <br /> _ � <br /> Project Address(if known) � <br /> Attach fuur(4) copies of plans for Groposed work- Drav: to scule anA ncte the lollowing as apUlicable: � <br /> • Property Lines �� <br /> • Center!in� of sireet I _ <br /> • OuUine and dimensions ot all existing and • Indicate North v� <br /> proposed siructures cn the Iot • Show any proposed c�ratling changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE �q <br /> PERMITCONDITIONS r ' <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. �� <br /> 2.All wcrk shall be pedormed in accordance with this permit and current City of Everett Design and Construction � <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-$00-424-5555. <br /> � <br /> � <br /> '��8��0 4MORKS PERMI? � <br /> A;Of REqUJREn <br /> xy,�' (A <br /> rsq�'r V♦ <br /> ..�1j , 0 <br /> a. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersignetl owner/applicant hereby agrees to hold and save ha�m� <br /> � less ihe Gty of Evere�� from any and all claims for damac�es. costs. <br /> � eapenses. or causes of action that may arise because o( installation <br /> � and maintenance ot �he improvement or other righbof�way use herelo <br /> Approved lor Con�Vuction I ann��Pd ior and further aqrees to remove same upon notice Irom the <br /> Dale Ci(y and to repl,qce public properry damaged thereby. <br /> i <br /> I <br /> FINAL INSPECTION � Uate I <br /> Approved as Constructed Signature o'App6cant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MIiST BE STARTED WITHIN <br /> 3200CedarSireet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> ��T�' Everett,WA 98207 BE DI�IGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> I PROJECT OVEF'90 DAYS DURATION. <br />