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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: C 44102 <br />Applicat.Date: 04/14/94 <br />Job Addreee: 2919 NASSAU <br />Owner Owrter: NALHACH LAWRENCE <br />Applicant <br />Describe Proposed Work _ <br />Proiect Address (if Rnown) <br />� Pu011c work� Parmil � _ <br />emp. ao�. • <br />Pu01ic Work� Fn <br />Tota�Fee s _ <br />Lelt Appl Fee P�iO S— <br />BH�ncs Du� s _ <br />SEPA <br />Phone <br />Tenant: ' <br />Propoaed Uee: SINGLE FAMILY RESIDENCE <br />Deec. of Work: <br />INSTALL NEW ROOF, FOUNDATION� WINDOWS� Phone <br />KITCHEN, BATH AND LAUNDRY <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Attach lour (4) copies of plans for Aroposed work • Draw to scale and note the following as applicable: <br />• Properly lines <br />� Oulline end dimensions of all existing and <br />proposed structures on tha lot <br />� Existing and proposed utllitles <br />� Centerline ot street <br />� Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs, in advance • phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and current City of Everelt Design end Construction <br />Standards end Specif(cetlons. <br />3. Cell Location Underground Service 4B hra betore you dig. TOLL FHEE NUMBER 1•800•424-5555. <br />PUBtIC WORKS PERMIT <br />NOT REpV�RED <br />BY � <br />DATE <br />Approved for Construction <br />FINAL INSPECTION <br />Approved as Conslructed <br />����PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everelt WA 98201 <br />Phone: 259•8870 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less lhe City ol Everett Irom any and all claims for damages. costa <br />expenses, or causes ol action ihat may arise because ol installation <br />and maintenance of the improvement or other righhof•way use hereto <br />applied lor and lurther agrees to remove same upon notice from the <br />City and lo reptace public property damaged thereby. <br />SignaWre ol Applicanl vaie <br />WORK AUTHORIZED BY TH�S PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.��CT OVER 90 DAYS DURATION. <br />