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Date <br />Applicatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Prapased Y <br />Project Address pf known) <br />Plan Check No: C 38444 SEPA <br />Applicat.Date: 10/21/92 <br />Job Addrs: 2401 MUKILTEO BLVD <br />Owner: BRUSTAD KEN <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Work: <br />ADDN <br />OFFICE SET JOB SET <br />APPRVD FOR PERMIT: DATE_/_�_ gy <br />PuE�m Works Permll • <br />Biap. Deol. r _ <br />P�Elic Wad� Fee s <br />Tol�l Fee <br />leu AOVI Faa P�IU S <br />Balanca Due S <br />Zip Phone <br />Zip Phone <br />Atlach four (4) copies of Dlans tor proposed work - Draw to scale and nole the tollriwing as applicable: <br />• Property Lines <br />• Outltne and dimensions o( all ezisting and <br />praposed structures on the lot <br />• Existing end proposed utilities <br />• Centodine ol street <br />• Indicnte North <br />• Show �ny proposed grading changes <br />• Show msasurements <br />PERMIT CONDITIONS <br />1. All cells for Inspection shell be mede 24 hrs. in edvance - phone 259•881 O. <br />2. All work ahell be peAormed In accordance with thie permlt and curtent City of Everett Design end Constructton <br />Standards and Specifications <br />3. Call Localion Underground Servfce 48 hrs. before you dig TOLL FREE NUMBER 1-800�4245555. <br />PUBIIC WORK^a PERMIT <br />NOT REOUIRED <br />BY �� <br />D AT E ��'�A -' ''= <br />Approved for Construction Dale <br />FINAL INSPECTION <br />Approved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everatt, WA 98201 <br />Phone: 259�BB10 <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/epplicant hereby egrees to hold and save herm- <br />less the City of Everett irom any and all cleima for damages, costa <br />expenses, or causes ol action that may arise because of inslallation <br />and maintenence oi the improvement or other righhol•way �se hereto <br />applied fur end lurther agrees to remove same upon notice from the <br />City and to replece public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE '3TARTED WITHIN <br />;it0 DAYS OF DATE PEFMIT IS ISSUEO 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 />