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�ate pu0lie Wo�Ms 1'ermil• <br /> Application For Biap.Deo�• <br /> PUBLIC WORKS PERMIT Pu�ToisFeeFas S <br /> Leaa Appl Fee Paitl S <br /> Print or Type Only Bal�nce Due s <br /> Plan Check No: C 46908 SEPA <br /> Applicat.Date: 02/02/95 <br /> Job Addra: 2212 ROCKEFELLER AVE <br /> Owner Owner: LEAOY CELIE Phone <br /> Tenant: <br /> Propoeed Uee: SINGLE FAMILY RESIDENCE <br /> Deec. of Work: <br /> Applicant REPAIR FIRE DAMATE TO UPpER FLOOR — ADD NEW Phone <br /> ROOF <br /> OFFICE SET JOB SET <br /> Descrihe Proposed Work _ pppRw FOR PERMIT: DATE <br /> _/�/_ BY <br /> W <br /> Prolect Address(if known) � <br /> Attach four(4) copies of plans for propose0 work-Draw to scale and note Ihe following as appiicable: � <br /> • Property Lines • Centerline ol street � <br /> • O�lBne 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 THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All celis for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pertormed fn acwrdance with this permit and current Cfty of Everett Design and ConsWction <br /> Standards and Specification� <br /> 3.Call Location Underground Service 48 hra before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> r'UHLIC WORKS PER,h11T O <br /> NOf REOUIREIa <br /> �1Y � <br /> DATE �' s � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 7he undersigned owner/apnlicant he�eby agrees to hold and save harm• <br /> lesc the City of Everett from any and all claims for damages, costs, <br /> � expenses, or causes of aclion that may arise because of installation <br /> nnd mai,�tenance of ihe imprcvement or olher right•oFway use hereto <br /> Approved for Construction Date applied for and furiher agrees to remove same upon notice from the <br /> City and to replace public property damaged thereby. <br /> F�NAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WaRK AUTHORI7_ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA 98201 BE 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 OVER 90 DAYS DURATION. <br />