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TYPE OR PRINT ONLY <br />Owner <br />ApplicaM <br />atqn Fn <br />PUBLIC W RKS PERMIT <br />Describe Proposed Work _ <br />PRO �ECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />9200 Cedar Street <br />Everett, WA 98201 259•BB70 <br />Plan Ch�ck No� H 57253 <br />11pp11e�t.Dat�s 11 26 97 <br />Job 11ddr�s 811 VIER Wl►1' <br />Own�r: Cl►RP V718ILE <br />T�n�nts <br />Propo��d U��: SINGLB F71l�tILY <br />Da�c. of Norks <br />ADDITIONS TO DININ6 i LIVIN6 <br />srow►ae uia�► <br />� <br />Data <br />Pubiic Nbrks Pertnit 1 <br />Buildirp Permil 1 _ <br />_ . .. ...�•ks Fea f <br />BEPA <br />AESID6NC6 <br />ROOMB� 71DD <br />OFFICE S6? JOB SST <br />11PPRVD FOR P8R!(ITt DATS_I_I_ BY � <br />Attaeh laur (4) copies of plans tor proposed work - Draw to scaln and note ihe lolbwing il appllcabie: <br />Phone <br />Phone <br />•Proparty Lines 'Outtine and dimensions of all ezlsting and proposed structures on ihe Iot 'Existing and proposed utilities <br />'Centerline of street •Indicate North •Show any proposed grading changes 'Show meesurements <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 pertormed In accordance with this permit and curcent City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />Approved lor Construction Date <br />FINAL INSPECTION Da!e <br />Approved as Constructed <br />Mtllf{.Ip MHNIt� ��lWli <br />��T/�EOUIIIKI� <br />dY""—•It vL' <br />�ATF.�.__l�'.L! �__—�—� <br />� <br />O <br />/�� <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby eqrees to hold and save hertnleas <br />the City of Ever�tt from any and all claims lor damages, eosts, expenses, a <br />causes o1 action that may arise beeause o1 installation and maintenance ol <br />the Impmvement w othei right-ol-way ux hereto eppYed for and IurtMr aqtesa <br />to remove samo upon notke trom the City and to replace pudic p�operty <br />dameged ihareby. <br />Signature ol Applicant Data <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 780 DAYS OF DATE PERMIT IS ISSUED hND THEREAfTER IS TO BE DILIGENT�Y PURSUED TO <br />CAMPLEf10N. THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURAf10N. <br />