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r <br />J�rpl,cation For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 259-8810 <br />TYPE OR PRINT ONLY <br />Owner <br />Applicant <br />Describe Proposed Work _ <br />Plan Check No: B 53299 <br />Applicat.Date: 10/22/96 <br />Job AN CT <br />owner:614 CLIFFffO2tRD/NANN <br />Date <br />Public Works Permit It <br />Building Permit p __ <br />•ks Fee $ <br />SEPA <br />Phone <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Wot't:: _ <br />INTERIOR CONFIGURATION EL & CHANGE ROOF <br />OFFICE SET JOB SET_�� <br />APPRVD FOR PERMIT: DATE_/_/_ BY <br />PROJECT ADDRESS (if known) <br />Attach four (u) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot sExisting and proposed utilities <br />'Centerline of street 'indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�a P�bI�G U�orks re,-P*4 R�• <br />Approved for Construction Date <br />FINAL IIJSPECTION Date <br />Approved as Constructed <br />S <br />Cl) <br />ca <br />O <br />z <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to ho:d and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation <br />fora maintenance <br />of <br />the improvement or other right-of-way use hereto applied <br />her agrees <br />to rer,. +e same upon notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant <br />Date <br />WORK AUTHORZED BY THIS PEMIT MUST BE STARTED COMPLETION. TIHIS PERMIT M YRBE CANCELLED BY THE CITY IUPON ANY TTOPPAGE OF WI ORK ON THIS PROJECT OVER 90 DAYS DURATION.Y PURSUED TO <br />