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h�' <br />ay <br />,axx <br />C H <br />9y�+.�n <br />H y� <br />y 7H <br />�S C� <br />H� <br />'��] H'�J <br />C/] H <br />C7 O LT� <br />H t1 <br />O H <br />�nb <br />H LTl O <br />S] u n <br />9 H �1 <br />r z <br />HH <br />d� <br />c�7 C7 cn <br />��� <br />Z H [n <br />H O fn <br />Date , t <br />Application rof <br />PUBLIC WARKS PERMiT <br />Print or Type Only <br />Owner <br />Applicant <br />De;cribe Proposed VJork _ <br />Plan Check No: H 39R91 SEPA <br />Applicat.Date: 03/12/93 <br />Job Ac.irs: 725 HO�T AVE <br />Owner: DORSEY DAVE <br />Tenant: <br />Ptoposed Use: SINGLE FAMILY RE:.IDENCE <br />Desc. of Work: <br />KITCHEN/DI:JZtiG ADDN — 120SF <br />OFF?CE SET JOB SET <br />APP�2V0 FOR PER2:?T: DATE_/_/_ <br />F'i�Lc vlorka Pe�mtl • <br />D�e9� ocot • _ <br />Pu01�iC W0lh3 F¢B <br />To�al Fee 5 <br />LessApP� Fce PaiE �u <br />na:�._co�.:o s <br />Attach Wur (4� Gopies of plan; for proposed work • Draw ro scale and note me lollowing as apcbcable: <br />• Property Lines • Centerline ol street <br />• Outline and dimec;ions of all existing antl • Indiwte Norih <br />proposed structures on the lol • Show any proUoseC grading changes <br />• Existing and proposed utilities • Show measuremenis <br />LL <br />hor.e <br />Phone <br />PF.RMITCONDITIONS <br />fv � 1. All call; lor inspection shall be made 24 hrs. in advance- phone 259•B81 O. <br />�� 2. All work shall be pedormed in accortlance wi�h �his permi! and current City uf Evzreli Desi9n and Consiruction <br />Standards and Specllieations. <br />3. Call Lxation Und=rprcunC Screicc :G 1�,�:�.. ::•.;Icrc �cu ,:I�.;. TOLL FREE NURI6ER 1•80�-424-5555. <br />,_�. <br />_._�� <br />PUBLIC VJORKS PERh71T <br />NOT REpUIRED <br />av -�� <br />DATE �' i "� :: =- <br />,`---_ <br />Approved lor CanstfuCtion Oatc <br />FINAL INSPECTION Date <br />Approvetl as Cans�ructed <br />/9�� PUBLIC WORKS DEPARTMENT <br />; 3200Ced�rStrect <br />Everelt.'fJA �6201 <br />Phone: 259�F3810 <br />� � �, f< <br />e <br />ACf<NOVJLEDGE1dE�1T Of- CONDITIONS <br />'!hc unuerclgned owneUapp9cant hcreby agrees �o huld and save harm- <br />Icss Ihe Cily ol Evere�t irom any and all claims for dama9es, Cos�s, <br />ezpenses. or causes ol aclion that may arise hecause ol installation <br />and maiNenance ol ihe improvument or other ripht�of-way use hereto <br />npplied lor and lurther a9rc•rs to mmove same upon noticc irom the <br />City and to icploce publlc property d�ma9ed �hore6y. <br />Slpnalmo ol AppOcant Dale <br />WORK AUTfiORIZLD BY THIS PERMIT t�1UST E3E STARTED WITHIN <br />180 DAYS OF D�TG PERMIi IS ISSUED AN� THEREAFTER IS TO <br />BE DILIGENTLY PURSIJED TO COMPLETION. THIS PERMIT MAY BG <br />CANCELL[D 3Y THE CITY UPON ANY STOFPAGE OF WORK ON TfIIS <br />PROJECT OVP,R 90 DAYS �URATION. <br />