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�� � <br /> H <br /> C H <br /> � HfA <br /> H � � <br /> FC (� <br /> pH �1 <br /> yCH �tl - � I <br /> y � Date o�o��wo��.Pa,m,�. <br /> ��, �t omc.oeo�.• <br /> �i��� Application For <br /> � H PUBLIC WORKS PERMIT °°°��<w°«=F°° S <br /> ��g Ta�,�F�e <br /> �� �� lesel�ootFeePe�a S <br /> �"� �+ BalancaDue $ <br /> x t7� Prir,t or Type Only <br /> r y ; Plan Check tio: 8 38005 SEPA <br /> H Applicat.Date: 09/14/92 <br /> C)t1V� Job Addreea: 4432 RIDGEMONT DR <br /> G � Owner Owner: CONERY JIM '-�P Phone <br /> «� Tenant: <br /> y y Propoaed U3e: SINGLE FAMILY RESIDENCE <br /> y p y Deec. of Work: <br /> - Applitan� ADDITION & DECK ?Ip Phone <br /> OFFICE SET JOB SET <br /> Describe Proposed Work _ — <br /> APPROVED FOR PERMIT: DATE_/_/_ BY <br /> W <br /> Project Address(if known) � � <br /> Atlach tour(4)copies ol plans tor propo:etl work• Draw to scale antl note the lollowing as appliwble: � <br /> • Properry Lines • Cemedine ol sVicet /^ <br /> • Outline and dimensions of all existing and • Indicale Norih V� <br /> proposed structures on the lol • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> ; ; DO NOT WPITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> '�1 1,All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with�his permit and current City ol Everett Design and Construclion <br /> Standards and Specilications. <br /> 'a„' 3.Call Location Underqrountl Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> ' O <br /> i_I P�-%�.,� «,,.�,:�. ,, , ,:. � � ;;:.�� �.- �.., : � �- <br /> I � ' V) <br /> �_� ���f,�. � O <br /> �_� a <br /> r- <br /> I�' ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersignetl owner/applicant hereby aqrees to hold antl save harm� <br /> less the City ol Everett Irom any and all claims br damages, costs, <br /> expenses, or causes ol action ihat may arise because ol installation <br /> and mainlenance ol lhe improvement or other righ4obway use hereto � <br /> applied lor and �urthrr agrees to remove same upon notice Irom Ihe <br /> Approeetl lor Construction Date Cily and to replace public properly damaged Ihereby. <br /> FINAL INSPECTION Datc <br /> Approved as Constructed Signature ol Applicant Date <br /> � PUBLICWOFiKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarSlreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA98201 �E DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT JVER 90 DAYS �URATION. <br />