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S t�It <br />may <br />,axx <br />9 y In <br />rw <br />H � <br />l< zH <br />O XC <br />'it H 'r1 <br />rA H <br />n O C3r1 <br />q t7 <br />O H <br />� tv <br />O. 0 <br />> A <br />C 1-4H <br />gCal <br />H <br />t- <br />C7 u) <br />H O 1[0 <br />Date- <br />;A or, ll as lion ror <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />Plan Check No: B 39870 SEPA <br />Applicat.Date: 03/12/93 <br />Job Address: 2111 14CDOUGALL <br />Owner: RODENHIZER DON <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Work: <br />SFR ADDN <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/__/_ BY. <br />jxsy I Norio Works Permits <br />Bldg. Dept e <br />public Works Fee <br />Total Fee S <br />Less APPI Fee Paid <br />Balancs Due 4, <br />Phone <br />Zip Phone <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work • Draw to 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 />DO NOT WRITE BELOW TH S LINE <br />PERMIT CONDITIONS <br />'� � 1. All calls for Inspection shall be made 24 hrs. in advance •phone 259.88'10. <br />+ 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specillcations. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />+ease, PUBLIC WORKS PERMIT <br />NOT REQUIRED <br />B V !} <br />! s DATE / �> <br />I= <br />+�astatiev <br />Approver; for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />40 <br />PUBLIC WORKS DEPARTMENT <br />/e° J <br />3200 Cedar Street <br />Everett WA 98201 <br />Phone: 259.8810 <br />•tI � <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <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 replace public property damaged thereby. <br />Signature of Applicant Dale <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':IORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />