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Date __ <br /> PUCl2 Workt Permit� <br /> ApDlication For Bmp.oeo�.• <br /> PUBLIC WORKS PERM{T Publ¢WorkaFee <br /> .o�.�F« s <br /> Less Aool Fee Paio S <br /> Print or Type Only ea���«o�� s <br /> Plan Check No: B 49579 <br /> Applicat.Date: 09/26/95 SEPA <br /> Job Addrese: 2817 MEDORA WAY <br /> Owner �ner: RApELJE DUANE <br /> Tendilt: Lp Phone <br /> Propoeed Use: SFR/DECK <br /> Deec. of Work: <br /> DECK WITH HOT TUB <br /> Applicant <br /> Z'P Phone <br /> OFFICE SET JOB SET <br /> Describe Proposed Work . APPROVED FOR PERyIT: DATE <br /> __/_/_ BY <br /> Project Address(il knownl — � <br /> Attach four(4)copies of plans to� proposed work- Drav:ta -:��le antl ncle�he foilowing as apU�icab�e: <br /> � <br /> • Property Lines � <br /> • Outline and dimensions ol all ealsting and � Centerline ot slreet � <br /> proposetl slruc�ures on the lol � �^dicate Norlh <br /> • Existing and proppsed utilities � �how any proposed grading changrs <br /> • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMITCONDIiIONS O <br /> 1.All calls for inspection shali be made 24 hrs.in advance-phone 259-881 O, <br /> 2.All work shall be pedormed in acwrdance with;his permit and current City of Everett Design and Constmction � <br /> Standards and Specifications. <br /> 3.Catl Lxation Undergrountl Service 4B hrs.betore you dig.TOLL FREE NUMBER 1•800-424-5555. <br /> � <br /> iJBLIC UYONKS P�NMIT \�/ <br /> �':O'i 4FpUlRER <br /> ,y �c��—,yf � <br /> �ATF---. �{-��.� � <br /> � � -�—' <br /> O <br /> a <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> — The untlersignetl ownedapplicanl hereby agrees to hold and save harm� <br /> � less the G�y of Everetl Irom any and all claims lor damages. costs <br /> � ewpenses. or causes of action that may ariss because ol instailatior <br /> _ � and mamtenance ol the improvemenl or ofher righbol-way use hereto <br /> Approved for Conshuction Dale I appl�r,d lor and turther agrees to remove same upon nolice I�om Ihe <br /> � CRy and to replace public pronerty damaged ihereby. <br /> I <br /> FINAL INSPECTION � Date <br /> ApDroved as Consiructed <br /> ���� Signature of Applicant Date <br /> PUBLIC WORKSDEPARTMENT WORK AU7110RIZED BY 7HIS PERMIT MUST 8[ STARTED WITHIN <br /> 3200CedarStreet 790 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EverefL WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT Iv1AV BE <br /> Phone:259-0810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PRO,IECT OVER 90 DAYS DURATION. <br />