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Date <br />� <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />App�icanl <br />Describe Proposed Wor1 <br />Plan Check No: B 44964 <br />Applicat.Date: 07/20/94 <br />Job Addrese: 21b3 RAINIER AVE <br />Owner: CAMERON JETT <br />Tenant: <br />Propoeed Uee: nUPLEX <br />Desc. of Work: <br />REPLACE & ADD T� NEW DECK <br />OFFICE SET JOB SET_ <br />SEPA <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Pub�ic WorM Pnrm�� • <br />eie9. oem. • — <br />PuOheWor�yFee y, <br />TOIAI G!! <br />Less / oul Fee P��4 5 <br />Baia�ce0uc g <br />Zip Phonr. <br />Prolect Address 1�f known: .— � --�----� �-- <br />Attach four (41 copies ol plans lu� V�opu3ed v.'U�K � Dr�v: W�cai�� a❑a ncte �ha 'OIIUwiny as apphcdb�e: <br />• Property LineS <br />• Outline and dimensions ol alt existin9 and <br />prvposed structures on Ihe loi <br />• Ezisting and proposed utilities <br />• Centerlme nf street <br />• InCiC31? Norih <br />• Snew any r.roaoseA gratliny changr5 <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspeclion shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and currenl City of Everell Design and Construction <br />Standards and Specificalions. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />PUB NOTWREOU{RED �IT <br />9Y 'B <br />��ATE 2 5 <br />Approved lor Construction Dale <br />FINAL INSPECTION � Dale <br />Approved as Conslrucled <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Streel <br />�, Everett, WA 98201 <br />n�.,.... oco.00in <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The !i�d?�5�4netl owner/appliCant nereby agree5 to h01d and SacO harm� <br />�'i less the Cdy o� Everetl Irom any and ali claims for dameges. costs. <br />; exVenses. or causes ot action ihat may aris? because ol insta�lation <br />-.i- ����7 mmnt?nance n! ll+e improvement or other righFql•way use hereto <br />IaGl��:q�: lor end �urther agrees to remove same upon�nolice ��om Ihe <br />i C,;y ard lo rep�ace public properry damaged ihereby. <br />Signature ol Applicant '""'- <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />tA0 DAYS OF DATE PERMIT IS ISSUED AND THEFiEAFTER IS TO <br />BE DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />oon icrr rnica on naVR IlI IRATION. <br />