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_., , <br /> PuhLC WO�k�PNmll• <br /> Date ' <br /> Oitlp.Ocoi.• <br /> Applitallon For _ <br /> PUBLIC WORKS PERMIT Pu�TaTl�Feeiee g <br /> llss AOOt Fee PaiE $ <br /> BalanceDue $ <br /> Print or Type Only plan check No: a 45657 <br /> SEPA <br /> Applicat.Date: 09 23A/94 <br /> Job A�ner:ZBO�MANNRENEW BLVD <br /> Tenant: <br /> Propoeed Use: SINGLE FAMILY RESIDENCE �,p Phone <br /> pwner Desc. of Wotk: <br /> ADDITION <br /> Appiicant <br /> OFFICE SET JOB SET�:ip Phone <br /> APPAVD FOR PERMIT: DATE_/_I_ BY <br /> Describe Proposed Work - <br /> _ �� <br /> ..._._._...,..—'-- � . <br /> �roiecl Address(if knownl ^ ' ^ � <br /> �� <br /> 4tlach four�4) copies ol pl2ns lor propuseJ wurk• Dra'v.� lo scaW. .lnd nCt¢ U�e follCwing �5 3pUliceble: � <br /> • Property Lines • Cenlerline ot slreel <br /> • Outline and dimensions ol atl exisling antl • Ir.dicale Norlh <br /> proposed slructures on the lol • Show any rroaosed grading changes <br /> • Existing and proposed ulilities • Show measuremenls /� <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> . PERMITCONDITIONS ^ <br /> 1.All calis for inspection shall be made 24 hrs.in advance•phone 259-8810. <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction i� <br /> ' Standards and Specilications. � <br /> 3.Call Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•S00•424•5555. <br /> � <br /> � <br /> PUBLIC WOHKS PERM'T /A <br /> NOT REQUIREY N♦ <br /> �Y� - � <br /> �1ATE � a <br /> ACKNOWLEDGEMENT Of CONDITIONS <br /> 7he undersigned owner/applicant hereby agrees to hold and save harm- <br /> —�— � less Ihe C�ty ol Everett Irom any and all claims lor damages. costs. <br /> � expenses. or causes oi action Ihat may aris= because ot inslallalion <br /> � and ma�ntenance o! Ihe improvemenl or other righhol�way use hereto <br /> Ia����P�: lor and lurlher agrees lo remove same upon no;ice Irom Ihe <br /> xoved for Construction �a�P � Ci7y anC lo rep�ace public properry damaged Ihereby. <br /> i <br /> IAL INSPECTION � Dale I Date <br /> xovr.d as Conslructed Signature ol Applican! <br /> PUBLIC WORKS DEPARTMENT <br /> 80RDAYS OF� DATE PERMIT ISEIS3UED AND THEREAFTER �SHTO <br /> 3200 Cedar Slreel ' BE DILIGENTLY PURSUED TO COMPL�TION.THIS PEFMIT �+tAY BE <br /> Everell,WA 98201 C.4NCELLED BY THE CITY UPON ANY STOPPAGE OF b'JORK ON THIS <br /> �'. p,.pJFCI'OVER�JO DAYti OURATION. <br /> Phone:259•8810 <br />