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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />qppliwnt <br />Describe Proposed Work <br />Prolect Address 1i1 knownl <br />r. <br />PUEbc Wo�xs Permil • <br />910g. Ueol. � <br />Pu�l¢ Wo�ka Fee s <br />TodlFee <br />�ess A00�� Fee PaiE a <br />BalanceDuc S <br />Plan Check No: C 49477 SEPA <br />Applicat.Date: 09/13/95 <br />Job Addre: 2101 WhLNUT ST <br />Owner: WEILAND NEIL <br />Tenant: <br />Propoeed Uee: SItiGLE FAHILY RESIDENCE <br />Deec. of Work: <br />ADDITION - BEDROOM� BATH� VTILITY ROOM <br />OFFICE SET JOB SET <br />APPRVD FOR PERMIT: DATE_/_�_ gy � <br />Attach four (4) copies ot Plans lor proposed work - Drav.• to scele antl ncte Ihe lollowing as applicab�e: <br />• Property Lines <br />• Outline and dimensions ol all eaisGng and <br />proposed structures on the lot <br />• Ezisting and proposed utilities <br />• Genlerline ol streel <br />• Intlicate Norlh <br />• Show any proposed gratling changr.s <br />• Show measuremenis <br />Phonc <br />Phane <br />PERMIT CONDITIONS <br />1. A�I cells for Inspection shall be mede 24 hrs. in 3dvance • phone 259•8810. <br />2. All work shell be peAormed in accordance with this permit and current City of Everett Design and Constructlon <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />L�-�-/� �/� �lT,y. l,tJe�,.IG-,� <br />'UBUC WO�KS PERMI? n�'�- � <br />�OT REQWRED � `Z' �r,�� ��f�r� <br />�YT ,�D /u'�`u'iJ.f�"-c� /�`f� itia,t`a�t-�-�+-� <br />��,�Te_ l3 P�_ �,, .���- ti.��'�.ta,.., , ,�-� <br />� <br />���'� od rneo� o�-�.:. <br />/� <br />��v B�e.�/ � c�� <br />Approved for Construction Date <br />FINAL INSPECTION � Dale <br />ApProved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />,��-., ��w�- <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />N <br />O <br />a <br />lhe untlersigned owner/apPlicant hereby agrees to hold and save harm� <br />less the City ol Everet� Irom any and all claims for damages. cosis. <br />expenses. or causes of action Ihat may ari5= because oi installation <br />and mainlenance ol ihe improvemen� or other right�ol-way use hereto <br />apn��ed tor and lurther a9rees to remove same upon notice irom Ihe <br />Gty anA to replace public property damaged thereby. <br />Signa!ure ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEflMIT IS ISSUED AND THEREAFTER �S TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCEL:ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJEGT OVER 90 DAYS DURATION. <br />