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�( ation For � . <br /> � PUBLIC WURKS PERMIT Date � <br /> PUBLIC WORKS DEPARTMENT Public Works Pemtit N <br /> 3200 Ceclar Streel <br /> Everett.WA 98201 259•8810 Building Pormil N <br /> '(YPE OR PRINT ONLY public Works Fee E <br /> Plan Check Nos C 57540 SEPA • <br /> Owner — Applicat.Date: 12 30/97 Phone <br /> 7ob Addreea: 11 21 1ST AVE SE <br /> Owner= ANDREW3 CLAYTON 8 <br /> Tenant: <br /> Applicant Pfopoeed Ueot SINGLS FAMILY RESIDENCfi phone <br /> Deec. of Work: <br /> ADDITION <br /> Describe Proposed Work _ � <br /> OFFICE SET JOH SET <br /> APPROVED FOR PERMIT: DATfi_/_/_ BY � <br /> � <br /> � <br /> PROJECTADDRESS(if known) � <br /> Atlach four(4)coples of plans lor proposed work•Draw to scale and note the foilowing 11 epplicable: <br /> •Property Lines 'Outline and dimensions of all existing and proposed structures on the lol •Existing and proposed utilities O <br /> •Centerline ot street •Indica�e Nonh •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1. All calls for inspection shall be mede 24 hours in advanc�- phone 259-8810. O <br /> 2.All work shall be performed in accordance with this�ermit and current CI i of Evereti Design and <br /> Constniction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> ■u1�►.ta �rau�� I�G�iu� � <br /> k6�uu� O <br /> 3Y <br /> �I1TE_�'�li�� a <br /> �� ' �� 2I��eZrS �.���� � ��e.w ac������ w-, I I �.e, <br /> v� � I �, a�- -�ti.E, �x'i sb�,�, S;�c se�'_ — i-� <br /> �o � i�: �'��-� I�e. �� �ra�t d k-e w-c.P-�- c1.1�C . o(� <br /> �e (o«�-fe� c�.� s��c 6 -F r�� , lc�;�� -�'� ��^ �-. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agraes to hold and save harmless <br /> the Ciry of Everett from eny and all cleims lor damagas,costs,expenses,w <br /> Approved for Construction Dale causes ol action that may arlse because of Installation and meintenance of <br /> the improvement or other rigM•oFway use herato applied for and lurther agraes <br /> to remove same upon notice frcm the City and to replace puWic ploperty <br /> damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed <br /> Signature ot Applicent Oa�e <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEf10N.THIS PERMIT MAY BE CANCELLED BY THE Cltt UPON ANY STOPPAGE OF WORK ON THIS PRQIECT OVER 90 DAYS DURATIOIJ. <br />