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P�Olic vlarxe Permil+ <br /> Date � � �� eiaq.oea�.+ <br /> Applicatic. .�or <br /> pUBLIC WORKS PERMIT PuGlicWorksFee g <br /> Toiai Fee <br /> Less AoOI Fee Pa�C S <br /> Balance�ue S <br /> Print or Type Only <br /> Plan Check No: C 40054 SEPh <br /> Applicat.Date: 03/29/93 Phone - <br /> Owner Job AdOWner: CHESTERFIELDAROB <br /> Tenant: <br /> Proposed Jse: SINGLE FAMILY RESIDENCE phone <br /> Deec. of Work: <br /> Applicant BEDROOM/dATH ADDN � <br /> Describe Proposed Work <br /> OFFICE SET JOB SET <br /> APPROVED FOR PERMIT: DATE_/_I_ BY <br /> � <br /> Project Address(if known) � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note�Ceoterline ot stPee�able: � <br /> • Property Lines � Indicate North <br /> • Outline and dimensions of all existing and � Show any proposed grading changes <br /> proposed struclures on the lot � Show measurements M <br /> • Existing and proposed utililies W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS ^ <br /> 1.All calls tor inspeclion shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be pertormed in accordance with ttiis permit and current City of Everett Design and Construction r <br /> Stan�ards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500•424•5555. <br /> O <br /> � <br /> PUBLIC �`10RKS PERMIT ♦A <br /> NOT RE�UIRED N♦ <br /> onTe' _'9`9� O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersiqned owner/apP�icanl hereby agrees to hold and save harm- <br /> less ihe Ciry ol Everett from any and all claims for damages, costs, <br /> expenses, or causes ot action that may arise because of installatiun <br /> and maintenance of the improvemenl or olher righbof-way use hereto <br /> applied for and further agrees to remove same upi.o notice liom lhe <br /> Approved for Construclion Date City and to replace public property damaged ihereby. <br /> Date Date <br /> FINAL INSPECTION Signalure ol Applicant <br /> Approved as Conslructed WORK AUTHORIZED BY THIS PEr7MlT MUST BE STARTED WITHIN <br /> PUBLICWORKSDEPARTMENT 180 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Sireet BF DILIGENTLY PURSU[D TO COMPLETION. THIS PERMIT MAY BE <br /> Everell,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJEGT OVER 90 DAYS OUNATION. <br />