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y M <br />N � <br />H <br />c .�°+ <br />N <br />H � <br />� � � <br />�C M 'V <br />N M <br />� H � <br />o � �1 <br />M W R <br />G1 • <br />t+ <br />M <br />�] <br />1r N <br />N <br />O N <br />��rtq <br />O tn <br />Dale <br />Applicatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />Prolect Address (il knownl _ <br />Plan Check No: C 36079 JZC, <br />Applicat.Date: 03/23/92 93L <br />Job AdOwner: •,�CN��OppETTOME <br />Tenant: <br />Proposed Uee: SINGLE FAMILY RESIDENCE <br />Deec. of Work: <br />5765F ADDITION — BEDROOMS AND BATH <br />OFFICE SET JOB SET_ <br />APPROVED FOR PERt7IT: DATE__/_I <br />: �m� c wan a P.�mn . <br />eiau oeo�. • — <br />o�o�,�wo,.,�., 5 <br />Tolal Fee <br />Les> �00� Fee Pa�O $ <br />Ba�anceDue S <br />�-�M <br />Zip Phone <br />qttach lour (4) copies ol Plans lor pmposed work - D�aw to scale and note � Cenitedine ol stpee�cable: <br />• Property Lines • Indicale North <br />• Outline and dimensions oi all existing and � ghow any Proposed grading cnanges <br />proposeo structures an the �ot � Show measuiements <br />• Esisting and prOposed utiliUes <br />PEfiM1T CONDITIONS <br />1. All calls lor inspection shall be made 2d hrs. in advance - phcne 259•8810. <br />2. All work shall be pedormed in acwrdance with this permit and current City ot Everetl Dcsign and Consirudion <br />Standards and Specilicatlons. �. <br />3. Call Location Underground Service 4' hrs. belore you dig. TOLL FREE NUM9ER 1-800•424•5555. <br />� ,S.LGG'r. ,��-'G<<.:��_ t a-c--:— <br />1 -_ ��f ,1:�:�, �l <br />C�ritL':v /�`efd :,.��e�c--� . ����'.�+ <br />� . �_ <br />__ <br />/ /ru.� - <br />�/, �) �; %'74 � =<�.� � <br />�/ J�h���"� � /.. j,/t_u -r'<. '1� �!�'�i, .�(— <br />�,,; ,n .. , . <br />Approvetl lor �onstruclion Dalo <br />FINAL INSPECTION Date <br />Approved a5 ConStruCtOd <br />��PUBLIC WORKS DEPARTMENT <br />�, 3200 Cetlar Street <br />Everett, WA 98201 <br />Phone:259�8810 <br />Z <br />�,; � O <br />�" H�/� <br />V♦ <br />J O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less Ihe City ol Everelt Irom any antl all claims tor Gamages, costs. <br />CaPenSCs, or Wu5e5 0l aciiOn Ihai may afise 6eCau5e ot in5talla�ion <br />and maiNenance ol the impmvemenl or other righPol-way use hereto <br />apPlied tor and lurther agrees lo remove same upon notice ��om Ihe <br />C�ry and lo �ep�ace pu6lic pwperty damaged thereby. <br />SignaNre ol Applicant Datc <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTFD�WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEPEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT h1AY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WOFK ON THIS <br />PROJECT OVER 90 DAVS DUF:ATION. <br />