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ti. <br />Date ��3 9� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work _ <br />Pro(ect Address (if known) <br />Plan Check No: <br />Appllcat.Data: <br />.7ob Addra: <br />owner: <br />Tenant: <br />Propoeed Uee: <br />Deac. of Works <br />REMODEL <br />B 35218 SEPA <br />O1/03/92 <br />1416-1b-20-22 PINE ST <br />EVERETT HOUSING AUTHORITY <br />LOW INCOME HOUSING <br />OFFICE SET JOB SET <br />APPRVD FOA PERHIT: DATE_/_/_ BY <br />Attach four (4) copies of plans tor proposed work • Draw to scale end note ihe tollowing as applicable: <br />• Property Lines <br />• Outline end dimensions of ell existing and <br />proposed structures an the lot . <br />• Existfng and proposed utilities <br />PuElic Worka Permit • <br />ema.oao�.• ���/P i.f..c.�3.�Y� <br />v�eu� wo�k� F�e <br />Tolal Fee s <br />Leas �00� Fee P�IE s <br />Bal�ntt Due S <br />• Centerline of streel <br />• Indicate North <br />• Show eny proposed grading changes <br />• Shaw measurements <br />Phone <br />PERMIT CONDITIONS <br />i. All calls for Inspectlon shall be made 24 hrs. In advence • phone 259•8810. <br />2. All work shall be pertormed in accordance with this permit and current City ot Everett Design and Construction <br />Standards and Specifications. <br />3. Cell Locatlon Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />�� i �J � <br />'✓L/�jCct LJ-'z��— �1�.�.,.� � /''�c� �'yi�c. ��f� <br />O <br />ApprovedforConstruction Date <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />��PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett WA 98201 <br />Phone: 259•8810 <br />, �� <br />J <br />/ -0�- 9z <br />ACKNOWLEOGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City ot Everett from a�y and all claims lor damages, costs, <br />expenses, or causes of action that may arise because ol installetion <br />and maintenance of the improvement or other ri9ht•ol•way use hereto <br />applied for and turther agrees to remove same upon notice trom the <br />City and to replace public property damaged thereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY 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 RE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />