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Date <br />Applicaticn For <br />PUBLIC W1�RKS PERMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Work _ <br />Project Address (it known) <br />Plan Checic No: <br />Applicat.Date: <br />.7ob Address: <br />Owner: <br />Tenant: <br />Proposed Use: <br />Desc. of Work: <br />ADDITION <br />OFFICF S <br />C 41517 SEPA <br />08/03/93 <br />527 LEGION DR <br />HARSTAD DEVIN <br />SINGLE FAMILY RESIDENCE <br />JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ 8Y <br />Pueuc worws Perm�n , <br />Bitlg. DeO�� • <br />Pu01ic Works Fee <br />TolalFee $ — <br />Less AoO� Fee PaiC 5 <br />eaiance oue S <br />�P Phone <br />�P Phone <br />Attach lour (4) copies of plans for proposed work - Draw to scale and note ihe lollowing as applicable: <br />• Property Lines • Centerline of sireet <br />• Uutline and dimensions of all ex�sting and • Indicale North <br />proposed siructures on lhe lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show me2surements <br />PERMIT CONDITIONS <br />t. All calls for inspection sha;l be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pertormed in accordance with this permit and current City ot Everett Design and Consiruction <br />Standards and Specificetions. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-8Q0•424•5555. <br />pUBLIC WORKS pERMIT <br />NOT REOUIRED <br />BY ' <br />DATE �y % Y.� <br />Apprcved lor Constiuction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98207 <br />Phone: 259�E810 <br />Date <br />W <br />H <br />! <br />� <br />z <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees lo hold and save harm- <br />less the City o� Everett Irom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of inslalla�ion <br />and maintenance of the improvemenl or olher righl-of-way use here�o <br />applied lor and further agrees to remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />Sig�iature ol App!icant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAaTED WITHIN <br />80 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />': D::IGENTLY PURSUED TO COMPLETION. THIS PEIiM1T MAY BE <br />GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />