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wn w <br />OL PUBLIC W IS PERMIT <br />PUBLIC WOW DEPARTMENT <br />a2o0 ether M" <br />Everett, WA9M201 2WOSIO <br />TYPE OR PRINT ONLY <br />Plan Check Not B 55773 <br />Applicat.Date: 06/627/97 <br />Job Addreset 4509 iRAHURST AVE <br />Owner Ownert BRUMBAUGH DAVE <br />F <br />PU Vk tr. Pernik k <br />Bathing Pernik e <br />._ ...+oF-ee4— <br />SEPA <br />Tenant: <br />Deec�oedNUset SINGLE FAMILY RESIDENCE <br />Appkant — ADD BEDROOM ABOVE GARAGE <br />Describe Proposed Work OFFICE SET JOB SET ___ <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />PROJECT ADDRESS (if known) <br />Attach four (4) copies of plans 10'r WgXN d work - Draw to Scale and note the kAlo**V If applicsbb: <br />'Pr0PmY Lines 20utkne and dimensions of all existing and proposed structures on the lot sExMing and proposed utNities <br />'Centerline of street 'Indicate North sShow any proposed grading changes •Show meeauremmts <br />PERMIT CONDITIONS: <br />1. All cells for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be Wormed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifics -lions. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-M-424_SM <br />"UFLIC WORKS rSAW <br />NO YAP <br />SY <br />*ATE <br />Approved for Construction Date <br />FINAL INSr. ^T10N Date <br />Approved as Constructed <br />co <br />ca <br />O <br />M2 <br />z <br />O <br />ACKNOWLEDCEMENTOFCONDITIONS <br />The undersigned owner/ePPkwt hereby agrees to hold and save harmless <br />the City of Everett from any and all claims f w damages, Costs, expenses, or <br />causes of action that may adae because of Installation and maMlsrnsnce of <br />the Improvement or other ripM-cf-way use hereto applied for and further agrees <br />,0 remove Same upon notice from the City and to replace public property <br />damaged thereby. <br />l Stgnsturo of Applkent <br />Data <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />