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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Deacrlbe Propoaed Work _ <br />ProjeCt AdCress (if known) <br />Plan Ch�ok No: H 43859 SEPA <br />1►ppllcat.Dat�: 03/23/94 <br />Job Addr��s: 29Y8 p MUICILTEO BLVD <br />Ownars SW7INSON D71VZD <br />T�nant: <br />Ptopo�od Uso: G71RHCfi (SFR) <br />D��c. of Work: <br />NSfi DET11CH8L G71R71Gfi <br />OFFICE SET JOB SET <br />APPR01/8D FOR PfiRMITt D11T8_/_/_ <br />WOIk Workt V�rmll • <br />BIOµ O�DL • <br />wer_ wo�k� F•• <br />roi.�P.� i <br />L�u ApP� F�� P�IU S <br />B�I�M� Du� S <br />� Phone <br />� Phone <br />Attach lour (4) copies ol pl�ns lor proposed work - Drew to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and tlimenaions of all exfstinp end • Indicate North <br />proposed structures on tho lot • Show eny proposed grediny changea <br />• Existlnp and propoaed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calla lor inspsetfon ahall be made 24 hro. in advence - phone 258-8810. <br />2. All work nhall be performed in eccordance with this permit and current City of Everett Desipn and Conatruction <br />Standards �nd Speci(icatlona <br />3. Call Location Underqround Service 48 hra before you dip. TOLL FREE NUMBER 1-800-424•5555. <br />PUBLIC WpRKS PERMIT <br />NOT REpUIRED <br />8Y <br />DATE 9� <br />Approved lor Conslruction Date <br />FINAL INSPECTION Dale <br />Approved ae ConstruCted <br />�PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />EverotL WA E82ri1 <br />Phone�259-8810 <br />ACKNOWLEDGEMENT Of CONDITIONS <br />W <br />F- <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby eprees to hold and aeve herm• <br />lass the Cil; ol Everetl Irom any and all claims for damages, costs, <br />expensas, or causes of action that may arise because of Installation <br />and maintenance of lhe improvement or other righPol•way use he�eto <br />applied for and further agtees lo remove same upon notice trom the <br />City and lo replace public property dameged thereby. <br />Sipnature of Applicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF 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 />�nn �rrT rnrc� nn �eVS �i �RnT1r1N <br />