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L y <br />Date <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />DeSCribe PropoSed Work <br />Project Address (il knownl <br />Plan Check No: C 45728 SEPA <br />Applicat.Date: 09/30/94 <br />Job Addra: 553b S 2ND AVE <br />Owner: MCDONOUGH MARY <br />Tenant: <br />Proposed Uae: SINGLE FAMILY RESIDENCE <br />Deac. of Work: <br />FRONT PORCH ADDN 6 REMODEL 6 REPAIR <br />� <br />'uouc wo�xa Pmmn . __ <br />pl�p.00DL � <br />vum¢ wo�ke Fee <br />Tolal Fet 5 — <br />� Le31 Aopl FR! Pe�E S_ <br />80bOt! �u! � � <br />ip Phone <br />OFFICE SET JOB SET — _ <br />Zio Phone <br />APPRVD FOR PERMZT: DATE_/_/_ BY <br />4ltach louf (4) Copi¢S of p10n5 lor proposed wurk � Drav� to Sr.al9 anA note �ne fo�luwing as applir.able: <br />• Properfy lines <br />• Ou�lioe and dimensions ol ail exisBng and <br />proposed sfructures on Ihe lot <br />• Existin9 antl proposed utilities <br />• Cen�edine ol slreel <br />• Indicate North <br />• �how any r,r000sed gratling chan�r.s <br />• Show measurements <br />LINE <br />PERMIT CONDITIONS <br />1. AII calls (or inspection shall be made 24 hrs, in advance • phone 259•8810. <br />2. All work shall be performed in accordance wilh this permit and current City ot �verelt Design and Construction <br />Standards and Specificalions. <br />3. Call Localion Underground Service 48 hrs. betore you dig. TOLL FREE NUMdER 1-800•424•5555. <br />•'3UC WORKS PERMIT <br />hOT EOUIREA <br />:Y <br />�ATE �0 5� 95� <br />�roved lor Construttion Dale <br />IAL INSPECTION <br />�roved as Constructed <br />��PUBLIC WORKS DEPARTMENT <br />3200 Gedar Street <br />Everett, WA 9820t <br />Phone: 259-BB70 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� / <br />Z <br />O <br />H <br />� <br />O <br />a <br />The undersigned owner/applicznt herebyagrees lo hold and save harm� <br />less the Cdy ol Everett Irom any and all claims br tlamages. costs. <br />ezUenses. or causes ol aUlon Ihat may �arise because ol ins�allation <br />antl mamtenance ol Ihe impro�ement or olher right-of-way use herMo <br />aaN�ed lor znd lurlher agrees lo remove same upon notice Irom the <br />Ciey anr, to replace public property damaged thereby. <br />Signature ol Applican! Dale <br />WORK �UTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS i0 <br />BE DILIGENTLY PURSUED TO COMPIETION. THIS PERMIT 1.1AY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJ`cCT OVER 90 DAYS DURATION. <br />