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Date <br />-. <br />Application For <br />PUBLIC VI/ORKS PERMIT <br />Print er Type Only Plaa Check No: 8 42786 SEPA <br />Applicat.Date: 11/23/93 <br />Job Addreee: 1040 NORTH PARK DR <br />Owner: BISSELL TRUST <br />Tenant: <br />Owner Ptopoeed Uee: SINGLE FAMILY RfiSIDENCE <br />Deec. of Work: <br />HOUSE ADDN, REMODEL 6 DECK <br />Applicant OFFICE SST JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY, <br />Describe Proposed Work <br />Project Address (ii known) <br />,._. <br />PUGIic Works Permil • <br />eiao. oao�� • — <br />Puelic Worka Fea s <br />Tolel Fea <br />Less AOC� Fsa Paltl S <br />Bal�nce Due S <br />2ip Phone <br />Zip Phone <br />Attach four (4) copies ai plans lor proposed work - Draw to scale and �ote the lollowing as applicable: <br />• Properly Lines <br />• Outlinn and dimensions of all ezisting and <br />proposed structures on the lot <br />• Exisling and proposed utilities <br />• Cenlerline ot street <br />• Indicate North <br />• Show any proposed qreding chenges <br />� Show measuremenls <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 perfortned in accordance with this permit and curcent City of Everett Design and Construction <br />Standerds and Specificatlons. <br />3. Call Location Underground Service 48 hrs. betare you dig. TOLL FREE NUMBER 1•800�424-5555. <br />PUBLIC WORKS PERMIT <br />NO�yT R�EDUIRED <br />BY __r:1"� <br />DATF � p <br />Approved tor Construclion Date <br />FINAL INSPECTION Date <br />ppproved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everet4 WA 98207 <br />Phone:259-8810 <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 fmm any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of inslallation <br />and maintenance of the improvemenl or other righbof•way use hereto <br />applied lor and further agrees to remove same upon nolice from the <br />City and to replace public property damaged lhereby. <br />Signature of Applicant Dale <br />WOFiK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMITIS 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 />PROJECT OVER 90 DAYS DURATION. <br />