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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Puo'i•. works Permit • <br />BIEp. peD�� � __ <br />Publ¢ WoeMs Fee <br />Total FBe s' <br />Lass ADO� Fee PeiO S <br />BJanceOue S <br />Plan Check No: C 46651 SEPA <br />Applicat.Date: O1/OS/95 <br />3ob Address: 60b9 14AGNOLIA AVE <br />Owner Owner: DUNLAF JAMES zip Phone <br />Tenant: <br />Propoeed Uae: SINGLE FAMILY RESIDENCE <br />Desc. ef Work: <br />FIRE DAMAGE REBUILD <br />Applicant Zip Phone <br />OFFICE SET JOB SET <br />Describe Proposed Work _ APPROVED FOR PERMIT: DATE_/_/_ BY <br />Prolect Address (if knewn) <br />Attach four (4) copies of plans lor proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicale North <br />propoc�.ed structures on the lot • Show any pwposed grading changes <br />• Exi;ting and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />S. All call.s for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shal� be performed in accordance with this Fermit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 4B hrs. before you dlg. TOLL FREE NUMBER 1•800-424-5555. <br />�UBLIC WORKS PERMIT <br />PiQf REOUIREP <br />RY <br />uATE � G 9S <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Construcied <br />���I�� PUBLIC WORKS DEPARTMENT <br />32U0 Cedar Street <br />Everett, VlA 98201 <br />Phane: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITICNS <br />� <br />� <br />� <br />� <br />O <br />The undersigned ow: riapplicant hereby agrees to hold and save ha-m- <br />tess the City of Everelt from any and all claims for damages, costs, <br />expense�, or causes of aclion that may arise because of installation <br />and maintenance ot the improvement or other righDoi-way use hereto <br />applied for and further agree; to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature ol Applicant Da:e <br />WORK AUTHORIZED BY THIS FERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEFMIT IS ISSUED AND THEREl.�TER IS TO <br />BE DIL�GENTLY PURSUED TO GOMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />