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� auoo Fw Date �l <br /> PUBLIC VI�RKS PERMIT <br /> PUBLIC WORKS DEPARTMENT puplic Nbrks Permit N <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8810 BuiWing Pertnit II <br /> NPE OR PRINT ONLY Public Works Fee S <br /> Owner � Plpan Chack No: C 5/533/9 ggp� pnone <br /> APJobcAdd ess= 11004E9MARINE VISN DR <br /> Owner: TIDRICR CRl►IG ' <br /> �P����� Tenant: Phone <br /> Propoeed Uees SINGLE FAMSLY RESIDENCB <br /> Deec. of Work: <br /> 2ND STORY 11DDITION � <br /> Describe Proposed Work _ <br /> OFFICE SET JOB SET � <br /> APPROVED FOR PERMIT: DATE_/_�_ gy _ <br /> V� <br /> PROJECT ADDRESS(if known) � <br /> Atlach four(4)cropies of plans lor proposed work•Draw to scale and note the following if applicabla: <br /> 'Property Lines 'Outline and dimensions ol all existing and proposed str�eture;on Me lot •Existing and proposed utilitles O <br /> 'Centerline of straet •Indicate North 5how any proposed gradfng changes 'Shaw 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 259-8810. O <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 Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> V♦ <br /> O <br /> a <br /> ''iINLIC WORK� �HRM1T <br /> nor cnuier.n <br /> �v.._.....�^- <br /> rnTf......G��� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Tho undersigned owner/applicant hereby agrees to hold and save harmless <br /> the Ciry of Everett from any and all claims for damages,costs,expenses,or <br /> Approved lor Construction Date causes of action that may arise becausa of installatlon and maintenance of <br /> the impr�vement or other righbof-way use hereto applied tor and lunher agrees <br /> to ramove same upon notice from the Ciry and lo replaca public property <br /> dameged thereby, <br /> FINAL INSPECTION Dale <br /> Appmved as Constructed <br /> Slgnature of Applicant Deta <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DIUGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK JN THIS PR0.IECT OVER 90 DAYS DUMTION. <br />