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.,...�.., <br /> .4pplication For <br /> PUBLIC�.JORKS PERMIT °�b <br /> � PUBLIC WORKS DEPARTMENT Public Works Pertnit M <br /> 3200 CeAer Sheet <br /> Everetl,WA 98201 259-8810 Buliding PertnR M <br /> TYPE OR PRINT ONLY Pub�ic Works Fee 3 <br /> Plan Check Nos C 62321 $gP� <br /> AppLicat.Date: 04[29 99 <br /> Job l�d�ne�i Z�V�20H ROBB E BL� Phone <br /> Owner Tenant s <br /> Propo�ed Uees SINGLB FAMILY R86ID8NCS <br /> Deec. of Works phpne <br /> Applicant ADDITION <br /> OFFICS SET JOB S8T � <br /> Describe Proposed Work_ <br /> 1►YPROVED FOR PERHIT: D1�T6_/_I_ BY � <br /> � <br /> N <br /> PROJECT ADDRESS pf known) � <br /> Atlach tour(4)copies ot plens for proposed work-Draw to sca�e and note the following ii eppltcable: O <br /> Rroparty IJnes 'Outline and dimensions of all existing end proposad structures on lhe lot 'Eristtng end proposed utilfties <br /> `Centerline of street •Indicate North 5how any proposed grading changes 5how measuremants � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: <br /> 1.All calls tor inspection shall be made 24 hours in advance-phone 259-8810. O <br /> 2.All work shall be performed in accordance with this pertnit and current City of Everett Desfgn and <br /> Construction Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-4245555. <br /> N <br /> O <br /> °UDLIC �ORKS PLF��.i� � a <br /> MOT�GUIR�= " <br /> �Y� --- -. .. i <br /> �nr�_�_._��_ _ . . <br /> ACKNOWLEDCEMEN7 OF CONDITIONS <br /> The undersigned ownedapplicant hereby egreas to hold and seve hartnless <br /> the City oi Everett trom any and all claims tor damages,cosls.expenses,or <br /> causes of action that may arise because ot Instellatio�and maintenance of <br /> ppprovedforConstruction Date �ry��mp��¢ntorolherri9hFo1-weyuseheretoapplladtorandlurtheregrees <br /> to remove same upon notice from the CMy and to replece publk property <br /> • damaged thereby. <br /> FINAL INSPECTION Date - <br /> Approved as ConsWcted <br /> Signeture of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DIU�ENTLY PUP.SUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS WRAT70N. _ <br />