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Date <br />Appl(cation For <br />PUBLIC WORKS NERMIT <br />Print or Type Only <br />Plan Check Nos C 44101 SEPA <br />Jwner Appllcat.Datas 04/14/94 <br />Job Addre: 2917 NkSSAU <br />� Owner: NALBNCH LAWRENCE <br />Tenantt <br />Applicant <br />Describe Proposed Work _ <br />Project Address (il known) <br />Propoeed IIee: SINGLE FAMILY RESIDENCB <br />Deec. of Work: <br />INSTALL NEW FOIJNDATION� WINDOWS, KITCHEN, <br />HATH, LAUNDRY <br />Pu01ie Warks Parmll a <br />BIEO. D�O�. � - <br />PuElic Works Fee <br />Tol�l Fae s <br />�afa �DG� Fea PeiO S <br />Bai�nn uue S <br />OFFICE SET JOB SET <br />APPAW FOR PfiRMIT: DATE_/_/_ BY ' <br />Attach lour (4) copies of pla�s for proposed work • Dra•.v to scale and nole the lollowing as applica6le: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Exisling and proposed utllilias <br />• Centedine of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for Inspectlon ahell be mede 24 hra in advance • phone 259•8810. <br />2. Ali work ahall be performed in accordance wfth this permit and current City of Everelt Design and Construction <br />Standerds and Specificetions. <br />3. Cali Location Underground Service 4B hrs. befare you dig. TOLL FREE NUMBER 1-800•424•5555. <br />Approvetl br Construction <br />PUBLIC WORKS PERMIT <br />NOT REpUIRED <br />BY <br />DA7E /S 9S� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby egrees to hold and save herm• <br />less the City of Everelt from any and all claims lor damages, costa <br />expenses, or causes of action that may arise because ol instellation <br />and maintenance of the improvement or other right•of-way use hereto <br />applied lor and further agrees lo remove same upon notice from the <br />Date City and to replace public property damaged thereby. <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />��PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everet4 WA 98201 <br />Phone: 259�8810 <br />Sig�ature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS °ERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF �YORK ON THIS <br />PRnJFCT OVFR 90 �AYS DURATION. <br />