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Date <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pup�m Wor4a Vurm�t • <br />BIEg. Dept � _ <br />PUUhc Woas Fee <br />Toirl Fee S <br />Less �1001 Fne Paia S <br />ealance Ouc S <br />Plan Check No: B 45232 SEPA <br />Applicat.Date: OB/10/94 <br />Job Addra: 415 ROSE WAY <br />Owner: BEATON MONTE <br />Owner Tenant: Z�a Phonr. <br />Propoaed Uee: SLAB <br />Deec. of Work: <br />CEMENT SLAB FOR FUTURE GARAGE 672 SF <br />Applicant Zip Phone <br />OFFICE SET JOB SET <br />Describe Proposed Work APPRVD FOR PERMIT: DATE_/_/_ BY <br />Project Address lif knownt <br />A�tach four (4) copies ol plans br uroUosed wura � Drav: ta scaL� a�a ncte �ha tollcwing as applicable; <br />• P�operty Lines <br />• Owline and dimensions ol all exishnq antl <br />prop�setl slructures on the lot <br />• Existing and proposed uliiities <br />• Certerline ot Slreei <br />• Indicaln Norlh <br />• $hOw 2ny pfODOSBd 9tatlin9 Chan.]PS <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Ca�l Location Under�round Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />ApproveA for Construction <br />fINAL INSPECTION <br />Approved as Cons�ructed <br />�ArI�� PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireel <br />Everetl, WA 98201 <br />Phone:259�8810 <br />PUBLIC WORICS PERMIT <br />N,O�,�j� REOUIREP <br />�Y��r_ <br />��ATE��• ,Yl � iSL <br />Data <br />Da•e <br />ACKNOWLECGEPdENT OF CONDITIONS <br />W <br />H <br />_ / <br />� <br />O <br />Thn unAers�qnetl owner/appl�cant hereby agrees to hold and save harm� <br />j less Ihe Cily of Everett Irom any and all claims for tlamac�es, cosls. <br />� expenses. or cau6es of aclion that may ans� be[ause of installation <br />� and maintenance �! lhe improvement or nther righl�of�way use hereto <br />��ppl�F,' tor and lu'ther agree5 lo remOve Same upon notice Irom Ihe <br />� Gty .�nA to replace pubhc propeny damagetl thereby. <br />Sianature ol AP!`lican! Date <br />VJOR1: AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />t80 D�YS OF DATE PERMIT IS ISSUED AND THER[AFTER IS TO <br />BE OILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED E3Y TIiE CITY UPON ANY STOPPAGE OF WORK ON TMS <br />PROJECT OVER 90 DAYS DURATION. <br />