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i <br /> ' � Date `' ' I <br /> • ppplicalion For <br /> PUBLIC WORKS PERMIT public Works Pemil M I <br /> PUBLIC WORKS DEPARTMENT + <br /> 3200 Cedar Street Building Permit# <br /> Everett,WA 98201 (425) 257-8810 <br /> Public Works Fee u <br /> TYPE OR PRINT ONLY <br /> Plan Check No: B 62743 SEPA phone <br /> Owner Applicat.Date: 06�15/99 <br /> Job Ad�ner: WOLFE�BRUCE&ASAI.LY <br /> F'hone � <br /> Applicant Tenant: <br /> Propoeed Uae: SINGLE FAMILY RESIDENCE � <br /> Deac. of Work: <br /> Describe Proposed Work ._ <br /> DINING ROOM ADDITION — � <br /> OFFICE SET JOB SET _ �� <br /> APPROVED FOR PERMIT: DATE_/_/_ BY � <br /> _ � <br /> PROJECT ADDRESS (if known) O <br /> Attach four(4)copies plans for proposed work-Draw to scale and note ihe following if applicable: �\ <br /> •Property Lines •Outline and dimensions of all ezisling and proposed structures on the lot •Existing and proposed utiliUes � <br /> •Centerline of street •Indicate North •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS: <br /> 1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8870 � <br /> 2. Ail work shall be performed in accordan it t r it � urrent�iry of Everett Design. and <br /> Construction Standa�ds and Speciticati B' p NUMBER 1-800-424-5555. r^ <br /> 3. Call Location Underground Service 4 s r v i <br /> O <br /> a <br /> �JDLIC WORKS �ERM�'� <br /> �yOti�E,OUIflEPi <br /> (/n 1`V\ <br /> �V 1�1�_ _ .t� <br /> �ATE.����{-�-�----- <br /> I <br /> ACKtvOWLC-DGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save hartnless <br /> tlie Ciry of Everett trom any and all claims for damages,costs,expenses,or <br /> a.�� causes of action that may arise because o�installetion and maiitenance ot the <br /> pprove or ons ruc ion improvemenl or oCher right-of-way use hereto apAlied(or and further agrees to <br /> removo same upon notice from the Ciry and to replace public propeAy dam- <br /> aged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed igna ure o pp��n a e <br /> �MKPLEf10N.THISPERMITIMAY ECANCEUFDBYTHECRYUPONANYSTOPPAGE WORKONhIISPPOJECT�O RgOA W Tpp�,YPUflSUED1J <br />