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Date <br />�1 <br />Appllcati. . For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applitent <br />Describe Proposed Wark <br />Proiect Address (il known) <br />Plan Check No: <br />Applicat.Date: <br />Job Addreee: <br />owner: <br />Tenant: <br />kropoeed Uae: <br />Deec. of Work: <br />REMODEL <br />C 37967 <br />09/10/92 <br />39b6 RUCICER AVE <br />RONSER� ROSELINE <br />DUPLEX <br />SEPA <br />OFFIC& SET JOB S&T <br />AYPROVED FOR PERMITs DATE_/_/_ BY <br />^� <br />Puol¢ Work� P�rm1i • <br />BIEp. D�pl. � __ <br />Puelic wo�k. F�• <br />Tol�l fa� s <br />len AppL Fn P�iO S <br />8�4nc� Dw s <br />Zip Phone <br />Zip Phone <br />Attach four (4) copies ol plena lor proposed work - Draw to scele and note the following as applicable: <br />• Property Lines • Centerline of street <br />.� Outline and dimenaiona ol all exis!Inp and • Indicate North <br />proposed atructurea on the lot • Show eny proposed gradinp chan8es <br />� Exiatinp and proposed utilitiea • Show measurements <br />PERMIT CONDITIONS <br />1. All cslls for In�pectlon shall be made 24 hre. in advance • phone 259•881 O. <br />2. All work ahall be parfermed in accordance wlth thia permit and wrtent City at Everett Deeipn and Conatruction <br />Shnd�rdt �nd Spxlfiatlona <br />3. Call Locatlon Underpround Service 48 hrs. before you dip. TOLL FREE NUMBER 1•800�424•5555. <br />,���w��..:� �����...o <br />. �.� <br />� =�� "9 2 <br />Appmved tor Construction Dale <br />FINAL INSPECTION Date <br />Approved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Ceder Slreet <br />Everett, WA 98201 <br />P�one: 259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicanl hereby a8rees to hold and seve harm- <br />less the City ol E��eretl Irom any ana all cleims for damaqes, costs, <br />expenses, or causes of action that may arise because of installation <br />ana maintenance of the improvement or other right-of•way use hereto <br />applied for and lurlher agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1E0 DAYS OF DATE PEfiMIT IS ISSUED AND THEREAFTER IS �TO <br />BE D�LIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUPATION. <br />