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Date <br />Application For <br />PUBLIC WORKS PERMiT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe ProDosed Work . <br />Prolect Address (il known) <br />Plan check No: <br />Applicat.Date: <br />Job Addreae: <br />Owner: <br />Tenant: <br />Propoeed Oee: <br />Deec. of Work: <br />DECK <br />B 36761 SEPA <br />�5b15�9� <br />48 7 S 3RD AVE <br />LANE� KEI�LY <br />SINGLE FAMIi�Y RESIDENCE <br />OFFICE SET JOB SET <br />I�PPROVED FOR PERMIT: DATB_/_/,_ BY <br />� I PUEIic Work� ParmX • <br />BICp. Deot • <br />Pue6c Wo�ks Fea <br />TotH Fee : <br />Leaa �00� Fes P�iG s <br />B�4nn Dua S <br />'.ip Phone <br />'ip Phone <br />Attach four (4) copies ot plans for proposed work • Draw to scale and note Ihe following as applicable: <br />�• Property Lines • Centerline ol street <br />• Outline and dimensions ol all existing and • Indicete NoAh <br />proposed atructures on the lot • Show any proposed grading changes <br />� Exiating and propoaed utililies • Show measurements <br />PERMIT CONDITIONS <br />1. All cells for Inepection shall be made 24 hn. in advance • phone 259•8810. <br />2. All work shell be peMormed in accordance with thla permit end cuvent City of Everett Design and Construdion <br />StendarCa and Specificetlons. <br />3. Cali Locetion Underpround Service 48 hra before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />7 �. - <br />/ c.'� �<..G GilPt.�-,/ �Ii'-t.��,�. � ��� !. ��ci<,r�� <br />I�^ <br />� <br />�r �7- y,� <br />Approved for Construction Date <br />F:NAL INSPECTION <br />Approved as Constructed <br />��PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everetl, WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ot Everett irom any and a�l claims lor Eameges, costs, <br />ezpenses, or causes of action that may arise because oi installation <br />and maintenance ol the improvement or other righFof-way use hereto <br />app�ied for and further agrees to remove same upon notice from Ihe <br />City and �o replace public property damaged thereby. <br />Date <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY Bt_ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATIOtJ. <br />