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Date <br />Applicatlon For <br />PUBLIC �,NORKS PERMIT <br />Print or Type Only <br />Owner <br />Plan Check No: <br />Appl'.cat.Date: <br />Job Addresa: <br />Owner: <br />Tenant: <br />Proposed Uae: <br />Desc. of Work: <br />2ND STORY ADD <br />DECK <br />C 48584 SEPA <br />06/12/95 <br />8523 XAVZER WAY <br />MICHAELIS JERRY/CINDY <br />SINGLE FAMILY RESIDENCE <br />N ABOVE GARAGE 6 2N0 STORY <br />PuOpe Woek� Pamll • <br />BMp. Dao� � - <br />ae„� Wo,.. F.. s <br />.o�.� F.. <br />Uu AOD� Fu PHE S <br />Ba4n<� Du� i <br />Zip Phone <br />OFFICE SET JOB SET Zip Phone <br />Apt�licant <br />APPROVED FOR PEFiMIT: DATE_/_/_ BY <br />Dascribe P�oposed Work <br />Project Address (It known) <br />Altach lour (4) copies ol plans fo� proposed work • Draw to scale and note the tollowing as applfcable: <br />• Progeiiy Lines • Centr.rline of streel <br />• Outlina and dimensions ol all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utllities • Show measurements <br />PERMIT CONDITIONS <br />1, All calls for inspectbn shali be mede 24 hrs. in advance � phone 259•8810. <br />2. All work shall be peAormed in eccordance wilh this permit end curtent Cily ot Everelt Design and ConstNction <br />Standards end Specilicatlona <br />3. Call Location Underground Service 48 hra beforo you dig. TOLL FREE NUMBER 1-800-424•5555. <br />PUBLIC WORKS PERMIT <br />NOi REQUTAED <br />sY <br />�3ATE � / — <br />Approved for Conslructfon Dale <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />���I�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everetl, WA 98201 <br />Pho ie: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />�w <br />_ / <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ol Everet� Irom any and all claims for damages, costs, <br />ezpenses, or causes of action that may arise because of installation <br />and maintenance of Ihe improvement or other ri�ht•of•way use hereto <br />applied (or and tunher agrees to remove same upon notice trom the <br />City and to reptace public property damaged lhereby. <br />Signalure ol Appifcant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br />BE DILIGENTLY PUR::UED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ��NY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />