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TYPE OR PRINT ONLY <br />•_•,keNo� F« <br />PUBLIC 1h �RKS PERMIT <br />p� Mr <br />APPIIcant M; <br />Describe Proposed Work <br />PROJECT ADDRESS (f known) <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Evereri, WA 98201 259-8810 <br />Date <br />Public Works PertnN M <br />Building Permit M <br />Public Nbtks Fee i <br />SEPA Phona <br />Plan Check No: H 49882 <br />Applicst.Date: 10[26[95 <br />Job A�ner:6CAVNERTDARYLA� . <br />Tenant: Phone �� <br />Piopoeed Uee: SINGLfi FAMILY RESIDENCE <br />Deec. of Work: <br />GARAGE/MASTER BEDROOM ADDN <br />OFFICE SST JOB <br />APPRVD FOR PERMIT: DATE_/_/_ BY <br />Attaeh four (4) coples of plans for proposed work - Draw to scale and note the toilawing if applicable: <br />7ioperty Lines `Outifna and dimansions of all ezisting and proposed structures on the lot •Existing and proposed utililles <br />`Centerline of street •Indicate North 5how any proposed grading changes •Show measuremenls <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-4245555. <br />�uouc woRKe P��e�,. <br />NOT qEGWRiI� <br />�y � <br />�➢ATE � <br />p,pproved for Constr�ction Date <br />FINAL INSPECT70N Date <br />Approved as Constructecl <br />� ��.e„_ B,t, ta•�,v`� <br />s� � � <br />io,� � ��,,,� c � . <br />W <br />� <br />� <br />N <br />m <br />O^ <br />♦ <br />� <br />O <br />� <br />N <br />O <br />a <br />ACKNOW LEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmlass <br />the City oi Everett from any and all claims for damages, costs, expenses.. or � <br />causes ui oction that may arise because of installation and maintenance of <br />the Improvement or other right-of-way use hemto applied for and further agrees <br />to remove same upon notice from iha City and to replace public property <br />damaged thereby. <br />Signature of Applicanl Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITIi1N 180 DAYS OF DATE PERMIT IS ISSUED AND TIiEREAhTER IS TO BE DILIGENiLY PURSUED TO <br />COMPLEf10N.7H15 PERMIT A1AY �E CANCELLED BY THE CITY UPON.ANY STOPPAGE OF WORK ON THIS PRO.IECT OVER 90 DAYS DURATION. <br />