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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />Project Address (it known! <br />I <br />r Public Works Permit <br />I Bldg. Dept. a <br />Public Works Fee <br />Total Fee 5 <br />Less ApplFee Paid 5 <br />Balance Dee $ <br />Plan Check No: B 44569 SEPA <br />Applicat.Date: 06/03/94 <br />Job AddrB: 27 W INTERCITY AVE <br />Owner: ROBINSON DON Phone. <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Work: <br />STORAGE BUILDING Phone <br />OFFICE SET _JOB SET <br />APPRVD FOR PERMIT: DATE_/_/_ BY <br />Attach four (4) copies of plans for proposed work - Draw to scam ana note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate North <br />• =now any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All culls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit 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 1.800-424.5555. <br />Approved for Construction <br />PUB NOPKS <br />T R .061146L M1f <br />BY y 3 Y L <br />DATE <br />UBLIC WORKS PERMIT <br />NOT REQUIRED <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />WORKS DEPARTMENT <br />CLPUBLIC <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />PUBLIC WORKS PERMIT <br />NOT REQUIRED <br />BY _ <br />DATE <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />0 �wj <br />M <br />O <br />z <br />O <br />The undersigned owneNappncart hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages costs. <br />expenses. or causes of action that may arise because of installation <br />-l- and maintenance of the improvement or other rigf+of-way use hereto <br />' applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST DE STARTED WITHIN <br />180 DAYS OF DATE PERM;T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />