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� � <br />H <br />�H� <br />��� <br />"{1N� <br />� � � <br />OMd <br />n <br />�,�g <br />t' y � <br />HH <br />g� <br />H <br />n�ti <br />�O� <br />Date <br />� <br />Application For <br />PUBL.IC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Descri6e Proposed Work <br />Project Address (il known) <br />TO POSTING <br />Plan Check No: C 37144 SEPA <br />Applicat.Date: 06/25/92 <br />Job Addre: 617 OLYMPIC BLVD <br />Owner: PROVENCHER TED & PAT <br />Tenant: <br />Ptopoeed Uee: SINCLE FAMILY RESIDENCE <br />Deec. of Work: <br />77SF UTILZTY ROOM ADDN — UNHEATED <br />OFFICE SET JOB SET <br />APPRVD FOR PEAHIT: DATE_/_/_ BY <br />Puebc wo��� Pe�mit s <br />Blap Deo�. � _ <br />Puoi¢Wo�xaiee J'��./� <br />Tolal Fee S Y <br />�ea �oo� Fee Paia 5 <br />Bal�nce Oue S <br />Attach lour (4� copies ol plans for proposed work - Draw to scale and nole Ihe lollowing as applicablc� <br />• Property Lines • Centerline ol sireet <br />• Outline and dimensions ol all exi5ting anA • Indicate Norih <br />p�oposed siructures on Ihe lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />Phone <br />P�one <br />PERMIT CONDITIONS <br />1. All calls lor fnspection shell be made 24 hrs. in advance - phone 259•.:810. <br />2. All work shall be pertormed in accordance with this permit ar,d current City ol Everett Design and Constructlon <br />Standards and Specilications. <br />3. Cali Location Underground Service 48 hrs. before you dig. TOLI. FREE NUMBER 1�6J0•424•5555. <br />7 <br />%C// L _ . . ..� . � �. . , � <br />Approved br Conslruction Dale <br />FINAL INSP[CTION Date <br />Approved as Constructed <br />/�`�PUBIIC WORKS DEPARTMEN7 <br />3200 Cedar Sireel <br />Everet4 �NA 98201 <br />Phonr.: 259�8810 <br />��,,. .;�� � <br />,. ,_' i , . <br />ACKNOWLEDGEMENT OF CONDI110N5 <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />Iess Ihe Ci1y ol Everelt Irom any aod all claims for damages, costa <br />ezpenses, or causes ol action ihat may arise 6ecause ol inslallation <br />and maintenance ol Ihe improvement or other right-ol�way use hereto <br />applied for and lurther agrees to remove same upon notice Irom Ihe <br />City and to replace public property damaged Ihereby. <br />Signature of ApPlicant Dale <br />WORK AUTHORIZED BV Tf115 PEfiM1T 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 BE <br />CANCELlEO BY THE CITY UPON AN'/ STOPPAGE OF WORK ON TH�S <br />P(70JECT OVER 90 DAYS OURATION. <br />