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�atf� � �� Publi[WorksPormiis <br /> Applicalion For aieg.oeP�.. <br /> PUBLIC WORKS PERMIT �u�T�aIF¢eFac $ <br /> Less Aool Fee Paid �_ <br /> Print orType Only Plan Check No: C 44389 SEPA BalancaDue S., <br /> Applicat.Date: OS/16/94 <br /> Job Addrs: 2524 LOMdARD AVE <br /> Owner: RED CROSS <br /> ;enant: <br /> Proposec: Use: SINGLE FAMILY F.n�IDENCE <br /> Owner Desc. of Work: Zip Phone <br /> NEW FDN,ROOF,2AINT,KITCHEN, BA:i: REMODEL <br /> Applicant OFFICS SET JOB SET _ Z�P phon2 <br /> APi'R7D FOR PERMIT: DATE_f_/_ BY__ � <br /> DescriAe ProFosed WorX <br /> — � <br /> Project Address(if known) _ � <br /> Attach four(4) cr;:us cf plans for proposea work- Draw to scale and note the tollowing as applicable: � <br /> 0 Property Lines s Centzrline of strr;et /w <br /> • Outline and dimeisionz of all existing and • Indicale North V, <br /> procns.��+sirucWres on'he lot • Show any proposed grading chanyes <br /> • Er.istiny a� d proposed utilities • Show measurements � <br /> ��. <br /> DO NOt WRITE BELOW THIS LINE O <br /> PERN . ,_ONDITIONS <br /> 1.All��ils f�r inspection shall be made 24 hrs.i�advance•phone 259•881 O. � <br /> 2.All work shall be performed in accordance with ihis permit and current City of Everett Design and Construction <br /> Standards and Specifications. � <br /> 3.Call Location Underground Service 43 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � <br /> PUBLIC WORKS PERMIT � <br /> NOT REQUIRED <br /> BY.��S' 'w■ <br /> OATE 5�` �1� VI <br /> i � <br /> � <br /> ACKNOWLECGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims tor dzmages, costs, <br /> expenses, cr causes of action that may arise because of installation <br /> and maintenance of lhe improvement or other right-of�way use here;o <br /> applidd for and further agrees lo remove same upon notice trom the <br /> .4pproved for Consirudion Date Cily and to replace public property damaged thereL•y. <br /> FIMAL INSPECTION Da•e <br /> Approved as Constiucted Signature of Applicant Dale <br /> PUBLi�WORKS DEPARTMENT WORK AU7HORIZED BY THIS PERMIT MUS' BE STARTED WITHIN <br /> :f200CedarStreet 180 DAYS OF DATE PERMIT IS ISSlIEO AND THEFEAFTER IS TO <br /> Evere;t,WA9A201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8870 CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> f'ROJECT OVER 90 DAYS DURATION. <br />