2109 MCDOUGALL AVE 2018-01-02 MF Import

1tion For 00�r PUBLIC WORKS PERMIT PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 982201 259/-8810 TYPE OR I RINT ONLY 0� Date Public Works Permit N Building Permit N _ Public Works Fee $ _ Owner Plan Check No: C 57456 SEPA Applicat.Date: 12 16 9 JJob Address: DOUGALL AVE Owner: COBB TINA Applicant Tenant: Proposed Use: SINGLE FAMILY RESIDENCE Desc. of Work: Describe Proposed Work _ BEDROOM / BATH ADDITION (RPII125-97) OFFICE SET JOB SET APPROVED FOR PERMIT: DATE_/_/_ BY PROJECT ADDRESS (if known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: •Property Lines •Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities -Centerline of s. aet •Indicate North `Show any proposed grading changes •Show measurements PERMIT CONDITIONS: 1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-8110-424-5555. Approved for Construction Date FINAL INSPECTION Date Approved as Constructed () co 0 z `0 rriA v♦ 0 CL ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harmless the City of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because o' installation and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the Chv and to replace public property damaged thereby. Signature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.