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Date PubIT WOr�S Pl�mil� I <br /> BiCO.�eot• .. <br /> Application For I <br /> PUBLIC WORKS PERMIT P�oTotaiFeeFee 5 <br /> Lev�oo�Fee PaiO S • <br /> Batann Oue 5 ! <br /> � �� Print or Type Only ; <br /> i <br /> � y I <br /> 9 H fA Plan Check No: C 35999 SEPA � <br /> y ' <br /> Owner Appllcat.Date: 03/16/92 Phone I <br /> y �N Job Addrese: 2203 AOCKEFELLER , <br /> Owner: HAA3CS �OROTHY J I <br /> Ter,ant: <br /> p x p Propoeed Use: SINGLE FAMILY RESIDENCE phone <br /> y � M Applicant Deac. of Work: <br /> REPLACE FOUNDATION� AOTTEN FLO�R� ROOF - <br /> .� LAUNDRY AOOM AREA <br /> p Describe Proposed Work JOB SET <br /> y d OFFICE SET -�—� <br /> OH <br /> M � � ppPROVED FOR PERMIT: DATE_/_/__ BY <br /> ^,V � <br /> zy� W <br /> � p.� y Frolect Adtlress(il known) � <br /> ty y <br /> O H Attach lour(4)copies of plans lor prnposed work-Draw to scale and note Ihe lollowinq as applicatle: �� <br /> n� y • Property Lines • Centerline ol streel ♦^ <br /> ti • Outline antl dimensions ol all eaisting and • Indiwte Norlh V� <br /> �'� proposed structures on Ihe lot • Show any proposetl grading changes <br /> Qy • Existing antl proposed utilities • Show measurements � <br /> 00 NOT WqITE BELOW THIS LINE O <br /> . PERMIT CONDITIONS <br /> 7,All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 1 2.All work shall be pedormed in acwrdance with thic permit and current Ciry ol Everett Design and Construction <br /> Standards and Speciticatlons. <br /> 1_=1 3.Call Locatlon Underground Service 4B hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. ' � <br /> � <br /> + ��� � r , � <br /> , . H� � �,�:�� � �.� � _��-- �-'�� .,� <br /> ' ����� � <br /> �, � �_� ,;� � O <br /> � -- <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> __ The undersigned owner/applicanl hereby agrees to hold and save harm• <br /> less the City ot Everett trom any and all claims lor tlamages, costs. <br /> _ expenses, or causes oi action Ihat may arise because of installation <br /> antl maintenance ot Ihe improvement or other righPol�way use hereto <br /> applied lor and lurther agrees to remove same upon notice irom the <br /> dpproved for Construction Date City and lo replace public pwperty damaged thereby. <br /> FINAL INSPECTION Date <br /> Approvetl as Constructed Signature ot Applicant Date <br /> PUBLICWORKSDEPARTMENT N'ORK AUTHOFiIZED BY THIS PERMIT MUST 8E STARTED�WITHIN <br /> 3200CetlarSlreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> A.�- BE DILIGENTLY PUFSUED TO COMPIETION. THIS PERMIT MAV BE <br /> �„ Everotl WA 98201 CANCELLEG BY THE CI7Y UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT O�EF 90 DAYS DURATION <br />