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. y Pua��c 1va�wf Pe�mu. <br />� � Date=�i�-"� <br /> � e�aa o�o�.• <br /> Application For <br /> ��� PUBLIC WORKS PERMIT Pubi¢WorkaFee 5 <br /> TOI�IFee <br /> p � � Lcv�opl Fee PeiC S <br /> I Gaiance0oe � <br /> y y uHi I Print oi Type Only <br /> 4 <br /> K�� I Plan Check No: B 37166 SEPA <br />, h�p H� ' Owner Applicat.Date: 06/26/92 Phone <br /> ,7ob Addrese: 1014 WETMORE AVE <br /> V�M I Owner: GEISSLER, DENNIS <br /> � Z � � Tenant: <br /> p Proposed Use: SINGLE FAMILY RESIDENCE Phone <br /> y C ', Applicant Desc. of Work: <br /> O H �y � DORMER ADDITION 247 <br /> ��`+ � Descrihe Proposed Work OFFICE SET JOH SET <br /> H <br /> y y � APPAOVED FOR PERMIT: DATE_/_/_ BY <br /> t� <br /> � y WN i <br /> �CC1N � � <br /> � [V t" �i Prolect Address(il known) - <br /> �y � <br /> � �I Attach lour(4)coDies ol plans br proposed work� Draw Io scale antl note lhe lollowing as app�icable: � <br /> � • Propedy Lines • Centeiline ol streel <br /> � 1 • Oulline and dimensions ol all existing antl • Indicale North <br /> pwposed struclures on Ihe lot • Show any proposed grading changes <br /> • Ezisting and proposed utllities • Show measuremems M <br /> � W <br /> r DO NOT WRITE BELOW THIS LINE O <br /> I �� � PERtrIITCONDITIONS � <br /> 1.All calls lor inspection shall L�matle 24 hrs.In advance-phone 259•8810. <br /> � 2.All workyha�l be peAormed in accortlanc^with this permit and currenl City ol Everett Design and Consiruction <br />� II Standards end Specilications. � <br /> I �� � 3.Call Localion Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> /' O <br /> ;'G� �. (���•:/-'-" ,_�- . , 1 � � �. �l�c. � , / <br /> / � �I _` I '/�, <br /> � �/ <br /> i O <br /> � <br /> a <br /> �� <br /> - � ACKNOWLEDG[M[NTOFCONUITIONS <br /> The undersigned owner/aPPlicant hereby agrees to hold and save harm� <br /> less the City of Everelt Irom any and all c�a1ms lor damages, costs, <br /> eapenses. or r,auses of aclion Ihal may arise because ol installalion <br /> and maintenance ol Ihe improvement or olher righ4ol�way use herelo <br /> applied lor and further agrees lo remova 5ame upon nolice from the <br /> Approved for Construction Dale City and lo rePlace public property damaged Ihereby. <br /> FINAL INSPECTION Dale Dale <br /> Approved as Conslructed Signalure of ApPlicant <br /> � ����'J� WORK AUTHORIZED BY THIS PERMIT A1UST BE STARTED WITHIN <br /> PUBLICWORKSD[PARTMENT 180 D�VS OF DATE PERA7IT IS ISSUED AND THERE�FT[R IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSl1E0 TO COMPLETION.THIS PERMIT MAY BE <br /> Everett WA 90201 CANCELLEU BY THE C�T�UPON ANY STOPPA6C OF WORK ON THIS <br /> PhOnC:259-8010 n n mr,r nvrn nn nnve n�mnnnni <br />