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Date <br />qpplicetlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: B 42606 SEPA <br />Applicat.Date: il/OS/93 <br />QW�e� Job Ad�ner: JOHNSONCFLORANCE <br />Tenant: <br />Propoeed Use: SINGLE FAMILY RESIDENCE <br />Applicant Desc. of Wock: <br />FOUNDATION UNDER EXISTING HOUSE <br />pyplit Wo�ks Pe�m11 • <br />B�ap.Oapt. � � <br />Pueiic Worka Fw s -�- <br />Toul Fee <br />Laas AppL Fe� V�IA s�� <br />B�lance Due i <br />A Work OFFICE SET JOB SET <br />Describe Propos^ , <br />APPROVED FOR FERMIT: DATE_/_I_ BY <br />Project Address (if known) licable: <br />Attech tour (4) copies ol plans lor proposed work • Oraw lo scale and nole the lollowin9 as app't <br />• Property Lines <br />• Outline and dimensions of ell ex:sting ai�d <br />proposed stru ft�ur�e9ed uNt Ies <br />• Existin9 and p P <br />• Centerhne of stree <br />• Indicale North <br />• Show enY Proposed grading changes <br />• Show measuremenls <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inapectfun shall be mede 24 hrs. In edvance • phane 259• <br />2, p�� yvork ahell be periortned �n accordenca with this permit end cuvent Clty of Everett Design and Constructlon <br />Stenderda and Speclticatlona. <br />3. Call Locatlon Underpround Service 48 hre. betore you diB• TOLL FREE NUMBER 1•800'424'555 • <br />Data <br />Approved fur Conslruction <br />Date <br />FINAL INSPECTION <br />qpproved as Constructer' <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everott WA 98201 <br />o�,,.�.• 259•8810 <br />W <br />H <br />- <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicanl hereby agrees to hold and save harm• <br />less the Ciry ol Everett from any and all cleims tor dameges, cost& <br />expenses, or ceuses of action Ihat may arise beceuse of instellation <br />andl ed'toe and fu�thte ea9reesV to eemove tsemeu Po r not ce9lromf the <br />app' <br />City and to replace public property dameged there y. <br />Date <br />Signature of APPlicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEF;MIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />PFOJECT OVER 90 DAYS DUR T ON. STOPPAGE OF WORI:ON THIS — <br />