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TYPE OR PRINT ONLY <br />Owner <br />Applicant - <br />Describe Proposed Work <br />I <br />Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257-8610 <br />DJ <br />Public Works Permit N <br />Building Permit N _ <br />Public Works Fee $ . <br />Plan Check No: C 62498 SEPA <br />Applicat.Date: 05/1899 <br />JJob Address: 3804 4UKILTEO BLVD <br />Owner: NIESER CLAUS/JEAN <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Work: <br />REBUILD PORTION OF GARAGE & ADD <br />LAUNDRY/UTILITY ROOM <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />PROJECT ADDRESS (if known) <br />Phone <br />Phone <br />Attach four (4) copies plans for proposed work - Diaw to scale and note the following if applicable: <br />• Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities <br />• Centerline of street • Indicate North • Show any proposed grading changes • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8610 <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications.. <br />3. Call Location Undergiound Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />Approved or construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />'UOLIC ORKS �ERMII <br />N OUIR61/ <br />*Y_T_WW_1___' <br />•ATI. _ �qL <br />W <br />srsn <br />�tI / <br />O <br />z <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to Fold and save harmless <br />the City of Everett from any and all claims for damages, casts, expenses, or <br />causes of action that may arise because of installation and maintenance of the <br />improvement or other right-of-way, use hereto applied for and further agrees to <br />remove same upon notice from the City and to replace public property dam- <br />aged thereby. <br />1gna re o pp icant Uale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUEL AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAYBE CANCELLED BYTTE CITY UPON ANY STOPPAGE OF WORK ON TM PROJECT OVER 90 DAYS DURATION. <br />