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TYPE OR PRINT ONLY <br />Owner <br />Applicant <br />liwtion For <br />Pl1BLIC lji►JRKS PERMIT <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPART��IENT <br />3200 Cedar Street <br />Everer, WA 98201 259-8810 <br />Plan Check No: <br />Applicat.Date: <br />Job Addreas: <br />Owner: <br />Tenant: <br />Propoaed Uae: <br />Desc. of Work: <br />REPL'nCE STORM <br />B 54916 <br />04/23/97 <br />6710 f,ARIMER RD <br />GRAHAM ELIZABETH <br />DAMACED GARAGE <br />Date� � <br />Public Works Permit # <br />Building Permit N _ <br />Public Works Fee $ _ <br />SEPA <br />OFFICG SBT JOB SET <br />APPROVED FOR PERMZT: DATE_/_/_ BY <br />Phone <br />Phone <br />Attach four (4) copies of plans (or proposed work - Draw to scale and note the following if applicable: <br />•Property Lines •Outline and dimensions of all existing and prcposetl siructures on the lot •Existin,o, and proposed utilities <br />•Centerline of s�reet •Indicate Norih •Show any proposed grading chanyes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 ho �rs in advance - phone 259-8810. <br />2. All work shall be perf�rmed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Un�+erground Service 40 hrs. be!ore you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�CJ �� Z�`f kS ��'wt (i' � Vlo � � rec�� <br />�`'� <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as ConsVucted <br />W <br />� <br />�w <br />� / <br />♦i� <br />V ♦ <br />� <br />� <br />ACKNOWLEDGEMENT OF COMDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett Irom any and all claims (or damages, cosis, expenses, or <br />causes of action Ihat may arise hecause of installation and maintenance of <br />the improvement or other nght-of-way use hereto applled for and lunher agrees <br />to remove sama upon notice from the Ciry and to replace public property <br />damaged ihereby. <br />Signature of Applicanl Date <br />WORK AUTHORIZ[D BY THIS PERI�IIT MUST BE STARTEO WITHIN 180 DAYS OF DATE PERMIT IS ISSUEU AND THEREAFfER IS TO 8E DILIGENTLY PUP.SUED TO <br />COMPLEfION. THIS PERMIT MAY I3E CANCELLED BY THE CITY UP'JN ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATI0IJ. <br />