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-a <br />� <br />Date <br />Application For <br />PUBLlC WORKS PERMIT <br />Print or Type Only plan Check No: C 49836 SEPA <br />Applicat.Date: 10/20/95 <br />Job Addrese: Slbl W MUKILTEO BLVD <br />Owner: HURLEY JAMES J <br />Tenant: <br />Owner <br />AppliCant <br />DesCribe FropoSed WO�k <br />PrOleCt Address (il known; <br />Propoeed Uee: SINGLE FAMILY RESIDENCE <br />Deec. of Work: <br />ADDITION TO KITCHEN <br />OFFICE SET JOB SET_ <br />APPROVED FOR PERHIT: DATR_/_/ <br />BY <br />6eb�¢ Wo�Ms Permn • <br />BIe9. oept • <br />Pueiic wo�ws Fee 5 <br />101T1 �CB <br />LP55 400L F?! Pd�O `S <br />BdIanCPOuC S <br />Zip Phnne <br />Zip Phone <br />Attath lour (4) Copies of pian5 �or proposed wu�k - D�av: lo aCaie d�l ncte :he'oilowing as apUGcab�e: <br />• Property Lines • Centerline ol street <br />• Outline and dimensionz ol all exishng antl • Intliwte North <br />proposed siructures on U�e lot • Show any r.roposed gratling chan4r.s <br />• Ezisting and proposed utilities • Show measu�ements <br />PEflM1T CONDITIONS <br />1. All calls lor 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 Everett Design and Construction <br />Standards and Specilications. <br />3. Calt Location Underground Service 48 hrs. before you diq. TOLL FREE NUMBER 1•800•424•5555. <br />for Construclion <br />�ua�rc wo�Ke P��+ui* <br />�;O'f R L�GE� <br />jY����s <br />y AT E __�� <br />Date <br />W <br />H <br />� <br />N <br />� <br />O <br />♦�A <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CGhDITIONS <br />The under�ioned owner/appiicxnt hereby agrees to hold and 5ave harm� <br />less ;he City o� Everett Irom any and ali claims for Oamages. cosls. <br />e*penses. or causes ol action Ihat may arise betause ot installation <br />and maintenance o: the improvement or other righl•ohway use hereto <br />app��rz�. lor and further agrees to remove same upon notice Irom Ihe <br />G;y and to replaca public property damaged thereby. <br />I <br />FINAL INSPECTION Date Date <br />Approved as Construded Signatura ol Applicao! <br />�A1I� PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT h1UST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200CedarStreet BE DILIGENTLY PURSUED TO :OMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLtD BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone:259-BB10 PRO.IECT OVER 90 DAYS DURATION. <br />