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Date_ <br />App:ication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Oescribe Proposed Work <br />Prolect Address S�� known) <br />Plan Check No: <br />Applicat.Date: <br />Job Acidrese: <br />Owner: <br />Tenant: <br />Proposed Uee: <br />Deec. of Work: <br />NEW FOUNDATION <br />OFFICE SET <br />B 46284 SEPA <br />11/22/94 <br />2202 HOYT AVE <br />DAVIS DON <br />SINGLE FAMILY RESIDENCE <br />JOB <br />APPROVED FOR PERMIT: DATE_/_/_ HY <br />Puoi�c Wada Perm�t • <br />BIEp. Depl. s _ <br />Publ¢Warx�Fee s <br />�otal Fee <br />Less Aoo� Fee Pa�tl � <br />ealance Due 5 <br />Attach four (4) copies of plans lor proposed work - Draw to scale antl note �he tollowing as applicable: <br />• Property Lines • Centerline of sireel <br />• Outime anJ dinren;ions of all existing and • Indicate North <br />proposed siructures on �he lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All calis for inspeclion shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and current City of Everetl Design and Cons�ruction <br />Standards and Specifications. <br />3. Call Location Underground Service 46 hrs. belore you dig. TQLL FREE NUMBER 1•800•424•5555. <br />� UBUC WORKS PERMIT <br />NO7 REOUIh�� <br />;y '� <br />u^.TE /i 2= ;' S• <br />?UBLIC WORKS PERMIT <br />M1OT REOUIREII <br />a r• <br />rATE <br />Approved tor Construction Date <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />�ArI�� PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everelt, WA 98201 <br />Phone:259�881C <br />ACKNOWLEOGEMENT OF CONDITIONS <br />W <br />� <br />� <br />N <br />� <br />O <br />■ <br />� <br />O <br />a <br />The undarsigned owner/applicanl hereby agrees to hold and save harm� <br />less the City ol Everell Irom any and all claims for damages, costs. <br />expense�, or causes ol action ihat may arise because of installation <br />and maintenance of Ihe improvemen� or other righ�-ol�way use hereto <br />applied for and lurther agrees to remove same upon notice Irom the <br />City and ro replace public proper�y damaged thereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1d0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCEILED BY THE CITY UPnN ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUF7�T�ON. <br />