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Date <br />ANplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: C 40312 SEPA <br />Applicat.Date: 04 20/93 <br />Job Addreee: 82 GRAND AVE <br />Owner: LANE DUANE <br />Tenant: <br />Owner propoeed Uee: SINGLE FAMILY RESIDENCE <br />Deec. of Work: <br />REMODEL RITCHEN <br />Applicanl <br />Uescribe Proposed Wor4 <br />Project Address (il known) <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Pu�Gc Wo�hs Pmmi1 • <br />e�aa. oao�. • — <br />PuLlie WoiW Fee s <br />TOIoI Fae <br />Lev Apo� Fee Paid $ <br />B�lence Due 5 <br />Zip Phone <br />L �0 <br />Attach tour (4) copies of plans for proposed work - Draw to scale and note Ihe lollowing as applicable: <br />• Property Lines <br />• Out�ine 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 />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. ^.tl calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance wilh this permit an�1 current City of Everett Design and Construction <br />Standards and Specifical(ons. <br />3. Call Locat�on Und�rground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />FUBLIC H10RKS PERMIT <br />NOT REOUIRED <br />B Y �� <br />DATE � �� 9? <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />�A1I�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259•BB10 <br />ACKN('iYVLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant h��reby agrees to hold and save harm• <br />less Ihe City of Everett Irom any anA all claims for damagea costs, <br />expenses, or causes of action that m3y arise because of installatfon <br />and maintenance of lhe improvemen! or other righhohway ese hereto <br />applied for and lurther agrees to �emove same upon nolice Irom the <br />City and to replace public p�oFerty damaged thereby. <br />Signature ol Applicanl Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DFYS OF DATE PERMIT IS ISSUED AND THEiiEAFTER IS �TO <br />8= 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 />