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� �iPuoi�c wo�ks Permn • <br />Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />aiay. o�o�� • — <br />Pom¢ wa�Ma Fee 5 <br />Totrl �ee <br />Less>oo�� Fee Pa�E S - <br />Bal�nceDue $ <br />Plan Check No: H 49411 SEPA <br />Applicat.Date: 09/07/95 <br />Job Addreee: 58i5 S 2ND AVE Ph��e <br />Owner Owner: DESROSIER JERRY JR <br />Tenant: <br />' Propoeed Use: GARAGE <br />Desc. of Work: __ — <br />qpplicant <br />NEW DETACHED POLE BLDG Phone <br />OFFICE SET JOB SET <br />Describe Proposed Work _ <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Projecl Address (ii knownl <br />Attach four (4) copies ot plans lor proposeu wo�K - Draw lo sca�e aaa ncte �he folluwmg as apUlicabie: <br />• Properry Lines • Centerline ol strvet <br />• Outline and dimensions ol all existing antl �� Indicale North <br />proposed structures on the lol • Show any proposed grading changes <br />• Existing and proposed utililies • Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance • phone 259•6810. <br />2. All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOIL FREE NUMBER 1•800•424-5555. <br />�— ,voE�: <br />�l% Pvbl�z worlc� �,r�;,� �v�v�d <br />S� ��e <br />wh� ; � w, �� <br />��� .� MeeE U./.'G• <br />I'IGuJ Q��;/c�in�' • <br />,,f,¢e t� �LEzche� �6� l� E-y m�ja+s <br />Approved for Consiruction Dale <br />FINAL INSPECTION � Date <br />Approved as Constructed <br />��rl�� PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Evere11, WA 98201 <br />Phone:259-8810 <br />AGKNOWLEOGEMENT OF CONDITIONS <br />W <br />H <br />�w <br />_ / <br />�n <br />C� <br />�� <br />The undersiqnetl owner/applicz�t hereby ag�ees to hold and save harm� <br />less Ihe City ol Everetl from any and all claims tor damages. costs. <br />ezpenses. o� causes ot action Ihat may anse because ol ins�allation <br />and mamtenance o! the improvement or other righbo4way use herelo <br />app��r;: lor and lurther agrees lo remove same upon nolice Irom Ihe <br />C�:y and to replace publir, proper;y damaged Ihereby. <br />re ol APPlicant <br />Date <br />WORK AUTHOFIZ[D BY THIS PERMIT MUST BE STARTED WITFIIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TH[(iEAFT[R IS TO <br />BE OILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLtD BY THE CITY UPON ANY STOPPAG[ OF WOFK ON THIS <br />PRO.IECT OVER 90 DAYS DURATION. <br />