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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plpan Check No: C 3fi96/4 SEPA <br />APJobcAddreeet 22�99HIGHLAND AVE <br />Owner Owners TABER, JESSE <br />Tenant: <br />Propoeed Ueet SINGLE FAMILY RESIDENCE <br />Deee. of Work: <br />ADDITION <br />Applicant <br />OFFICB SET JOB SET <br />Describe Proposed Work _ APPROVED � FOR PERMIT: DATE_/_/_ <br />Pro�ect Address (if known) <br />PUEI¢ Worha Permil • <br />eieo. o.o�. • — <br />Puobe Worq Fee <br />Tot�i Fae S <br />lnf �ppl Fas P�iC S <br />BH�nce Dve S <br />I ip Phone <br />i <br />Attech lour (4) copies ol plans for proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Llnes • Centarline of sireet <br />• Outline and dimensions of ail existing antl • Indicate Norih <br />proposed structures on the lot • Show any proposod greding changes <br />• Existing and proposed utllities • Show measurements <br />Phone <br />� . PERMITCONDITIONS <br />'�t 1. All calls lor Inepectlon shell be made 24 hrs. in advance - phone 259�8810. <br />2. All work ahall be performed in au:ordenca wtM thls permit and curtent City of Everett Desiqn and Constructlon <br />Standerda and �pecillcations <br />��' 3. Call Location Underpround Service 4B hrs. before you dig. TOLL FREE NUMBER 1•800�424•5555. <br />!// � 7 <br />/ l/rJ-rc�_c� Gc.rcz,%�2r'-z r � � , � . "L% r' ,L,. � .,� i c �: � <br />, �� <br />, G-/o--?� � <br />,%�p�i .See� S��'.L �7`� J-,ie,;�` LC-,�c�flril��.. ��Clc.,,✓���. y�.�t <br />/, /� J � <br />CC7Ji �" 4�yi�-�fiL'n.iin �L=> �'7�i-'���M cL��.��� � �� � •4-'� <br />` /� �C-Lc2r <br />�6%.,-.fj��� �i2.-�.t �/10)��, �iG._��C.L:,,� <�:�%� <br />i <br />Approved lor Consiructlon Date <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, V'A 98201 <br />Phone: 259•BB70 <br />W <br />� <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/appiieant hereby agrees to hold ar..: save harm- <br />�ess the City ol Everett from any and all cleims for damages, costs, <br />expensea or causes of action ihat may arise 6ecause of installation <br />and mainlenance ol ihe improvement or other right•of•way use herelo <br />applied for and further agrees to remove same upon notice Irom ihe <br />Cily and to replace public property dameged Ihereby. <br />Signature ot Applicant Date <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT 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 />PROJ�CT OVER 90 DAYS DURATION. <br />k <br />`''+. <br />