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-- - - .� <br /> Date o�o�,«�a,.s�.,m,. <br /> eiag oeot� <br /> ApP�ication for <br /> PUBLIC WORKS PERMIT vU�iola��eeFPe S <br /> Le5sAo01 FnePaiO S <br /> Bd�dOCPCuC S <br /> Print or Type Only <br /> Plan Check No: C 49031 SEPA <br /> Applicat.Date: 07 24/95 <br /> 3ob Addreae: 10 02 1ST DR SE <br /> Owner: LEITCH JEFFREY <br /> Tenants <br /> Owner Proposed Uee: SINGLE FAMILY RESIDENCE .'_�: Pnnnc <br /> Deec. of Work: <br /> ENCLOSE CARPORT TO LIVING SPACE <br /> Applicant OFFICE SET JOB SET Zip Phone <br /> APPROVED FOR PERMIT: DATE_/_/_ BY__ <br /> Describe Proposed Work , <br /> ----------- .__ - W <br /> Prolecl Address(11 known! . - - � <br /> A�taCh(Our(n�COples 0� p�BnS�or prppo52d wu�K' D/Bv: IO Sf.dLT dn(1 nCie th�:O�lowing as 3pp6CaG�P.: � <br /> • Property Lines • Centerline M street /A <br /> • Outline and dimensions ol all exishng and • Ictlicate North V� <br /> proposed structures on the lot • Show any creposeA grading changes <br /> • Exisling and Froposed utilities • Show measurements � <br /> DO NOT WRITE BEI.OW THIS LINE O <br /> . PERMITCONDITIONS <br /> �_ . t.All calls lor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> • , , 2.All work shall be peAormed in accordance wilh this permit and current City of Everelt Design and Construction <br /> �� � Standards and Specifications. <br /> � 3.Call Location Underground Service 40 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> O <br /> UBLIC WGRK8 PERMI7 � <br /> �0'i REDUIRED � <br /> lY��_ - O <br /> :�P`--��:2S <br /> a <br /> ACKNOWLEOGEMENT OF CONDITIONS <br /> Tho u�dersiqnetl ownedapplicant hereby agrees lo hold and save harm� <br /> —'---� less ;he Gly ol Eve�etl irom any and all claims for tlamaqes. cosls. <br /> ; expensas. or causes ol action that mny aNss because oi installalion <br /> i and mamtenance o! Ihe improvement or other righhol•way use herelo <br /> appi�ed �or and lurlher agrees to remove same upon notice irom thc <br /> Approved lor Construction �a��' � Cdy anrf 10 replace pubhc prouerty damaged thereby. <br /> i <br /> FINALINSPECTION � D.te <br /> Approved as Constructed Signature ol Appfican! Date <br /> WORK AUTHOR12ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA�J8201 � CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PRO.IEGT OVER 90 DAYS DUAATIO\. <br />