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�ate Public Warks Parmit s <br /> Application For BIEp.Oept• <br /> PUBLIC WORKS PERMIT P�����W�«=FeB <br /> To�e�Faa a <br /> Less Apol Fae Paitl $ <br /> Balance Dua S <br /> Print or Type Only <br /> — Plan =heck No: C 39167 SEPA <br /> Owner Applicat.Date: O1/OS/93 Zip Phone <br /> Job Addrs: 2506 LOMBARD #`2 . <br /> Owner: GELLATLY TIMOTHY <br /> Tenant: <br /> AFalicant ProFoeed Uae: SINGLE FAMILY RESIDENCE Z�P phone <br /> Desc, of Work: <br /> REMOUEL OF BATHROOM & KITCHEN INCLUDING <br /> Descri6e Proposed Work . <br /> FOUNDATION <br /> OFFICE SET JOB SET <br /> AppRVD FOR PEPMIT: DATE_/_/_ BY <br /> W <br /> Project Address(if known) � <br /> Attach four(A)copies of plans br proposed work• Draw to scale and note the foilowing as applicable: � <br /> � Property Lines • Centerline of street /A <br /> • Outline and dimensions of all existing and • Indicate Norih N, <br /> proposed siructures on the lot • Show any proposed grading changes <br /> � Existing and proposed ulilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All cails tor inspection shatl bo made 24 hrs.in advance-phone 259-8810. � <br /> 2.AII work shall be performed in accordance with this permit and current Cily of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Cali Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> � <br /> � <br /> , PUBLIp WORKS p O <br /> NOT REOUIREpRMIT /� <br /> BY Ii■ , <br /> DATE g3 <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/2pp�icant hereby agreas to hold and save harm• <br /> - less ihe Ciry of Everett irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> i and maintenance of the improvement or other right-of•way use hereto <br /> applied for and further agrees to remove same upon nolice from the <br /> Approved for Construction Date City and to replace public property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> ���� PUBLIC WORKS DEPARTMENT WOfiK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> 320UCedarSireel 180 DAYS OF UATE PERMIT �S ISSUED AND THEREAFTER IS �TO <br /> Everett,WA 98201 BE DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />