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Date (y ��2� � <br />Application For ` <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pu01ic Works Permit s <br />einu. oec� • <br />Pub�ic Works Fee s <br />Total Fee <br />Less �oG� Fee PaiE S <br />Balanca Jue $ <br />Plan Check No: C 41172 SEPA <br />Applicat.Date: 06/30/93 <br />Owner Job Addresa: 6202 W MAGNOLIA AVE Phone <br />Owner: MILLER RICHARD <br />Tenant: <br />Proposed Uee: SFR/GARAGE <br />Desc. of Work: Phone <br />Applicant NEW GARAGE <br />Describe Proposed Work _ <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/,_ BY <br />Proiect Address (if known) <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicaAle: <br />• Property Lines • Centerline of streel <br />• Outline and dimensions of all cxisting and • Indicale North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show meesurements <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be made 24 hrs in advance - phone 259•8810. <br />2. Ail work shali be performed in accordance with this permit and current City of Everelt Design and Construction <br />Standards and Specitications. <br />3. Call Locatlon Underground Sorvice 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />PUBLtC WpqKS pEqMiT <br />NO�� REOUIRED <br />B Y .3'/ <br />OATE � �' i 3 <br />Approved for ConstruCtion Date <br />FINAL INSPECTION Date <br />Appmved as Constructed <br />�PUBLIC WORICS DEPARTMENT <br />3200 CeAar Sireet <br />Everelt, WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant herety agrees to hold and save harm- <br />less the City of Everett trom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because ot installation <br />and maintenance of the improvement or other right-of•way use herelo <br />applied for and further agrees to remove same upon notice trom the <br />Ciry and to replace oublic property damaged thereby. <br />Signature ot Applicant Dale <br />WORK AUThIORIZED BY THIS PERMIT MUST BE STARTE� WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />