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- .--. <br /> Date _ �,�m�wo,.,P�,m,�. —, <br /> Applicalion For oiaq.oeoi.. <br /> PUBLIC WORKS PERMIT PuM�cwo�k�Fee -- <br /> ToIAIF�� S �,� <br /> Lesf�ool Fee P�iE 5_ <br /> Print or Type Only Plan Check Noi C ��611 EEPA o+ia�ceo�e 5 _ <br /> Appllcat.Date: 09/19/94 <br /> Job Addrese: 16b5 t� SZLVER LK RD <br /> Ow[lez: GRAY DELORES <br /> Tenant: <br /> Propoeed Uee: SINGLE FAMILY RESIDENCE <br /> Owner Deac. of Wotk: 7_ip phonc <br /> ADDITION <br /> OFFICE SET JOB SET .. _. <br /> Ppplicant Zio Phone � <br /> APPAOVED FOR PERMIT: DATF._/_/_ BY <br /> Describc °roposed Work _ <br /> , _—'_'____'__'_—_ _ � <br /> Projecl Address(if knoN�n1 __ _ � <br /> 4tlach loui (4)r,opies ol plans br proposed wu:k• Drav to sr.�ba anA ncle �he Io�luwing as applir.a6le: � <br /> • Property Lines • Cenlerlina pl sireet ♦^ <br /> • Outline and dimensions ol all e.isting anC • Indicate Norlh V� <br /> proposetl structures on ihe lol • $how any,r,roaosetl grading changes <br /> • Ezisting and proposed utilities • Show measuremenls � <br /> DO NOT WRITE BEIOW 7HI5 LINE O <br /> PERMIT CONDITIONS <br /> 1,All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.Ail work shall be pedormed in accordence with this permit and current City of Everel!Design and Construclion <br /> Standards and Specifications. <br /> 3.Cell Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 0 <br /> `UBLIC WORKS PFRy�T � <br /> NOT qEOUIpE11 � <br /> 3V <br /> uATE_ 9 O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersianed owneNapplicxnl hereby agrees to hold and save�arm� <br /> -- � less the Cily of Everetl Irom any and all tlaims lor damages. cosls. <br /> � ezpenses. o� causes ol action Ihat may erls= because o: inslallalion <br /> � � antl mamienance OI Ih0 imprOVCmenl Or o�her righbpbway u5e herelo <br /> Iaan��et �or anA lurther agrees to remove same upon notice from Ihe <br /> �roved lor Construction Dalr. � G:y antl �0 replaGe public properiy damaged thereby. <br /> i <br /> IALINSPECT�ON ' Dale _ <br /> �roved as Conslrucled Signature ol Applican! Dale <br /> I� PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet iB0 DAYS OF DATE PERMIT IS ISSUED 4ND THEREAFTER IS TO <br /> Everelt,WA 98201 DE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS OURATION. <br />