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LT1 � <br />JD <br />9Hf~n <br />!! A <br />H xl <br />(A hdH <br />ti <br />H d <br />OH <br />HM <br />G�aa O <br />ZH <br />F3 +J <br />HH <br />gy <br />0tvW <br />19 <br />H CPA) <br />H0En <br />n Date .j/30 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: C 36162 SEPA <br />Applicat. Date: 03/30/92 <br />Job Addre: 623 MAULSBY LANE <br />Owner Owner: WARFIELD, MIKE <br />Tenant: <br />Applicant <br />Describe Propose <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Work: <br />ADDN OF FAMILY RM AND EXTEND BATHROOM <br />OFFICE <br />JOB <br />APPRVD FOR PERMIT: DATE_/_/_ BY <br />Project Address (it known) <br />Public Worka Permit e <br />Bldb. Deote 3LP,/6--7-. <br />Public Works Fee S <br />Total Fee <br />Less appt Fee Paid S <br />Balance Due S <br />Zip Phone <br />Zip Phone <br />Attach four (4) copies of plans for proposed work • Draw LJ scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />•Ir <br />Z <br />O <br />U) <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to repla, public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED 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 />