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� � � ! <br /> � PubliC Waike Pmmll♦ <br /> �O C Date eia�.oea�.+ <br /> � y y qpplicatian For <br /> ~ � " PUBLIC WORKS PERMIT '°°"""°'""`° 5 <br /> H Totalfeo <br /> O C O LessApDl.Fea Paia S <br /> Rj M �+1 <br /> y �y ealance Ouc S <br /> � � � Print or Type Only <br /> O N <br /> � '� n Plan Check No: B 36816 SEPA <br /> z H Applicat.Date: OS/22/92 Phone <br /> � y � Owner Job Address: 2117 LOMBARD AVE <br /> H y Owner: MIDDLESTETTER NORMAN <br /> o m Tenant: <br /> n d y Applicant Proposed Uae: SINGLE FAMILY RESIDENCE Phone <br /> q Desc. of Work: <br /> � h7 � REPLACE FOUNDATION <br /> y � y Describe Proposed Work <br /> OFFICE SET JOB SET <br /> APPROVED FOR PERMIT: DP.TE_/_/_ BY <br /> W <br /> Proled Address(il knavn) � <br /> Atlach lou�(�)copies ol plans tor proposed work � Draw lo scale and note lhe�ollowing as applicable: <br /> ��� <br /> • Properry Lines • Cer.terline of street � <br /> • Outline and dimensions of all ezisting 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 /� <br /> I � � <br /> �� PERMITCONDITIONS `s/ <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � � <br /> ! 2.All work shall be performed in accordance with ihis permit and wrrent City ot Everetl Design and Construclion <br /> � '�_ Standards and Specilications, ' � <br /> , 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800•424-5555. <br /> s e <br /> ✓�p � , � <br /> ���'/��. . _ L ��':!-.... �� _ , � � . . / _ , , � . � �'i <br /> _ W <br /> � �--' F- ' <br /> � <br /> -- � <br /> � �-- <br /> � <br /> o� <br /> I ' ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agrees to hold and save harm- <br /> i�� less �he Ciry ol Everetl lrom any and all claims for damages, costs. <br /> expenses, or causes of aclion that may arise because ot installation <br /> - � and maintenance of the improvement or other nght-ol�way use hereto <br /> applied for and further ac�rees to �emove same upon notice trom the <br /> Approved lor Construction Date Cily and to replace public property damaged Ihereby. <br /> FINAL INSPECTION Date — Date <br /> /-pproved as Constructed SignaWre of Applica�� <br /> WORK AUTHORIZED BY THIS PERNIT MUST BE STARTED WITHIN <br /> � PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMI7 MAY BE <br /> � �,. Everett,WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />