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� /,pplication For (uate __ <br /> � PUBLIC WORKS PERMIT <br /> PUBLIC WORKS DEPARTMENT Public Works Permit k <br /> 3200 Cedar Street <br /> Everetl,WA 98201 (425) 257-8870 Building Permit# <br /> TYPE GR PRINT ONLY Public Works Fee$ <br /> Owner Plan Check No.: C9909-002 phone <br /> Job Address: 1722 HOYT AVE <br /> Owner: FOSHEIM KELSEY <br /> Applicanl Trnant: Phone <br /> Application Date: 9/3/99 <br /> Proposea Use: DlJPLEX 1 � 1 <br /> Describe Proposed Vl�ork _ Type�f v:ork: CHIPS,DECK,UPGRADES ��J <br /> Offite Se� )ob SeY� Flre/Planning Set � <br /> Approved For Permit: Uate: By: ♦�^ <br /> V A <br /> PflOJECT ADDRESS (if knnwn) � <br /> O <br /> Attach four(4)conias plans for proposed work-Draw to scale and note the tollowing if applicable: � <br /> •Property Lines •Outline and tlimensions of all existing and proposed slructures on ttie lot •E:i;ting and proposed utililies <br /> �Ceniedine of street •Indicate North •Show any proposed grading changes •Show measurcments <br /> DO NOT WRITE BELOW THIS LINE Z <br /> PERMIT CONDITIONS: � <br /> 1. Ail calis for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br /> 2. HII work shall be per(ormed in sccordance v+ith this permit and current City of Everett Design and � <br /> Construction Standards and Specifi�:;uons. . <br /> 3. Cali Location Underground Servicc�48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. ♦A <br /> ♦/♦ <br /> NKS PERM� ' O <br /> '+UCLIC W VE,�UIPL� ' <br /> tv0� ^ , <br /> —�� r�re ' <br /> :Y_�— r <br /> q .�-- -- <br /> •ATF . "'_.. � <br /> h <br /> i <br /> t: <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The ur.dersigned owner/applicant hereby agrees to hold ar,d save harmless <br /> the Cit�of Everetl trom any and all clairr.s tor demages,costs,expenses,or <br /> ppmve or onstrucuon a�e causes of action that may arise becausn of instailatlon end maintenance of the <br /> improvement or other righhol•way use hereto applied lor and IuMer agrees to <br /> remove seme upon notice from ihe Ciry and to repiace public properry dam- <br /> aged thereby. <br /> FINAL INSPECTION Date <br /> Approved as ConstructeG <br /> �gnature u pp icant ate <br /> WORK AUTHORIZED BY THIS PERMR MUST BE STAHTED�'JI'THIN 180 DAYS OF DATE PERMR IS ISSUED AND 7HEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> WDAPLEf70N.THIS PERMIT MAY k3E GWCELLED BY THE ClTY UPON ANY STDPPAGE OF WORK ON 7}i�S PR�J,IECT OVEH 90 DAYS WRATION. <br />