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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicent <br />Describe Froposed Wc <br />Prolact Address (if known) <br />Plan Check No: <br />Applicat.Date: <br />3ob Addrees: <br />Owner: <br />Tenant: <br />Propoeed Use: <br />Desc. of Work: <br />FOUNDATION FOR <br />OFFICfi SET <br />S 39234 <br />O1/12/93 <br />2001 WALNUT ST <br />WOODARD LELAND <br />ruerc wo�k. ve�mn . _ <br />9iep. Dept. � <br />�'apLe Wo�kt Fee <br />Totsl Fee s — <br />leu �p0� Fee P�iE S— <br />B�bnca Due S — <br />SEPA <br />Zip Phone <br />SINGLE FAMILY RESIDENCE <br />EXISTING HOUSE <br />JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Attach four (4) copies ol plans for proposed work • Draw to scale and note � he followinB as applicable: <br />• Proparty Linas • Centerline of street <br />• Outline end dimensions of all exisling and • Indicate North <br />proposed structures On lhe lot • Show any proposed grad�ng changes <br />• Existing and proposed utilities • Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for Inapectlon ahall be made 24 hrs. in advence • phone 259•8810. <br />2. AII work shall be performed In eccordence with thia permit end curtent City ol Everett Design and Construction <br />Stenderda and Specificetlona <br />3. Cell Location Underpround Service 48 hrs. before you dig. TOLL FREE NUMBER 1-80Q�424•5555. <br />BIIFi�jF 1M6AKS PERMI� <br />NdT REpUIRED <br />BY- �� <br />DATE � '� "9� <br />� <br />ApDroved for Construction Date <br />FINAL I�SPECTION Dat^ <br />Approved as Conslructed <br />�A�PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everet4 WA 98201 <br />Phone:259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />T�e undersigned owner/aD�licant hereby agrees to holA and save harm• <br />less the Cily of Everett irom any and all cleims lor dameges, costs, <br />ezpensas, or Causes of action that may arise because of instailation <br />and maintenance ot the improvement ar other righl•ol•way use hereto <br />applied for anA lurther agrees to remove same upon nolice Irom the <br />City and to replace public property damaged ihereby. <br />Signature ol 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 PURS�ED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />