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Date <br />Application For <br />PUBLI� WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />Prolecl Address (if knewn) <br />Plan Check No: B 40377 SEPA <br />Applicat.Date: 04/26/93 <br />Job Address: 5912 LARIMER RD <br />Owner: BUNSELMEYOR MENANIE P <br />Tenant: <br />Proposed Uee: SINGLE FAMILY RESIDFNCE <br />Desc. of Work: <br />LIVING/DINING ADDN — COVE72F.D PORCH <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY. <br />^� Puelic WeMa Permil • <br />Blag. oeo�. • - <br />PuoueworksFee $ <br />Total Fea <br />Less A00� Fee PaiE � <br />6a�ance Due $ <br />�iP Fnone <br />Zip Phone <br />Attach four (4) copies of Plans for proposed work - Draw to scale 2nd nole � Ce���eWine of stPee1 able: <br />• Property Lines • Indicale North <br />• Outline and dimensions of all existing and � Show ary proposed grading changes <br />proposed structures on the lot • Show measurements <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-881 O. <br />2. All work shall te performed in accordance with this Fermit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1�800•424•555 . <br />B��N?Sr��iA��hil�' <br />ay�� <br />�IIfE y-zc: _9�• <br />Approved lor Gonstruction <br />Date <br />FINAL INSPECTION <br />Approved as Construcled <br />�Ap��;.y-_�. PUBLICWORKSDEPARTMENT <br />� 3200CedarStreet <br />�Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />�w <br />� / <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Cily of Everett Iram any and all claims for damages, costs, <br />ezpenses, or causes of action that may arise because o( installation <br />and maintenance oF the impmvement or other ri9hl-ohway usa hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public �xoperty damaged thereby. <br />Dale <br />Siqnature ol APPIicaN <br />pO�DAYSTOFO DATE PERMIT ISE SSUED ANDBTHEREAFTER ISHTO <br />BF. DILIGENTLY PURSUcD TO COMPLETION. THIS FERMIT MAY BE <br />CA�VGELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />