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Date <br />� <br />Appllcatlon for <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Descrlbe Proposed Work _ <br />Project Addrean (if known) <br />Plan Check No: C 45208 SEPA <br />Appllcat.Dates 08/09/94 <br />Job Addrees: 73b GRAND AVE <br />Owner: HLACKMORE RALPH <br />r4 <br />h�IIC Worb p��mll • <br />B10p. D�D�. � _ <br />Puellc NCM. Pu — <br />To1H Fa� S <br />L��� Apo� F�� p�10 f <br />Bal�nt� Du• { <br />Tenant: p Phona <br />Propoeed Uaes SINGLE F'�MILY RESIDENCE <br />Deec, of Work: <br />3 DORMERS, DECR, BATH, WET BAA <br />a Phone <br />OFFICE SF.T JOB SET <br />APPAOVED FOR PERMIT: DATE_/_�_ <br />Attach tour (4) copies of plans for proposed work • Drew to scale and note the following as applicable: <br />• Property Lines � Centerline af street <br />• Outline and dimenalons ot all ex�sting and • Indicate Narth <br />proposetl structures an the lot • Show eny proposed grading changes <br />• Existing and proposed utllities • Show measurements <br />PERM�T CONDITIONS <br />1. All calls for inspectbn ahall be made 24 hra in advence - phone 259-8810. <br />2. All work ehNl be pertormed in eccordance with thle permit and curcent City of Eve�ett Deaign hnd Conatruction <br />Standards and Specification:, <br />3. Call Locatlon Underqround Service 48 hra, before you dig TOLL FREE NUMBER 1$00�424•5555. <br />Np � J� f �' ��i/o��-k..s <br />Approved for Construction <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireat <br />Evmetl, WA 98201 <br />Phone: 25&8810 <br />,'�,�, � �.� <br />L'�`9''� <br />�i�ri� ��� ���,'� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />�" <br />� <br />O <br />a <br />The undersigned owner/appiicant hereby agrees to hold and save Aarm• <br />less the City of Everett Irom any and all claima for damapes, costa <br />expenses, or causea of aclion that may aiise becauae ol instellation <br />and maintenance of Ihe improvement or other right•of•wey 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 PEFMIT MUST 3E 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 />PROJECT OVER 90 DAYS DURPTION. <br />