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�,dte Peplle Wod�Peimil• <br /> Appllcelion For eiao.oao��• • <br /> PUBLIC WORKS PERMIT PueTotalFeaFaa s <br /> Len Aoo�Fes PaiE s <br /> B�lannoue S <br /> Print or Type Only <br /> Plan Check No: B 39623 SEPA <br /> Applicat.Date: 02/19/93 <br /> Job Addreee: 11b21 1ST DR SE <br /> Owner: DYKES TIMOTHY <br /> Tenant: Zip phone <br /> Owner Propoeed Uees SINGLE FAMILY RESIDENCE <br /> Deec. of Work: <br /> BEDROOM 6 GARAGE ADDN <br /> Applicant 2ip Phone <br /> OFFICE SET J08 SET <br /> Describe Proposed Worl <br /> APPROVED FOR PEAMIT: DATE_/_/_ BY <br /> W <br /> Projeet Address lif known) � <br /> � Attach four(4)copies of plans for proposed work•Jraw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of streel � <br /> • Outline and dimensions of all existing and • Indicate North <br /> � proposed structures on the lot • Show any proposed preding changes <br /> • Existing and proposed utilities • Show measuremenls � <br /> . . DO NOT WflITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> i.All calls tor inspectbn shall be made 2a hra.in advance-phone 259-8810. � <br /> 2.All work shall be performed in eccordence with ihis permit end current Clty of Evarett Deaign end Constructlon <br /> Stendards and Specilicatlona <br /> 3.Call Locetlon Underground Service 48 hrs.befare you diB�TOLL FREE NUMBER 1•800�424•5555. � <br /> O <br /> � <br /> PUBLIC WORKS PERMIT � <br /> NO REOUIRED O <br /> BY ` � <br /> DATE `� � ��� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the Gily of Everetl irom any and all claims for damages, costs, <br /> ezpenses, or causes cf action that may arise because of installation <br /> and mainlenance ot ttie improvement or other right•of•way use hereto . <br /> applied lor and further agrees to remove same upon notice from Ihe <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Dale Date <br /> Approved as Constructed Signature o1 ApPlicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �A� PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br /> 3700 Ceder Street BE DILIGENTL" PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Pnone:259�8B7a PROJECT OVE.R 90 DAYS DURATION. <br />