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Date <br />ApPlication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: B 43449 SEPA <br />Owner Appllcat.Dste: 02[03/94 <br />Job Addreee: 2227 STATE ST <br />O�anec: HAMILTON FORRfiST <br />Tenent: <br />Applicant Propoeed Uees SINCLE FAMILY RESIDENCfi <br />Deec, of Work: <br />CONSTRUCT CA[iPORT <br />Describe Proposed Work _ <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATB_/_/_ <br />Project Address (il known) <br />�i <br />Pu01ic Wa�ks Pamll • <br />BWp D�pL • <br />Pu01K Wonu Fa� s —_� <br />Total Fee <br />L�u Appl Fea P��O s�� <br />e�l�� Dw s —�—' <br />— Phone <br />Attach four (4) copiea ot plans for propased work • Oraw lo scale and note � Ceni�erline ol stPeet�ble: <br />• PropertY Linea � Indicale North <br />• Outline end dlmensions oi all eaistfnp and � Show eny proposed gradinp chenpes <br />proposed siructurea on the lot � Show measuremente <br />• Eaistinp and proposed utilities <br />P�one <br />PERMIT CONDITIONF <br />1. All calls tor inepectlon ahell be made 24 hra. In edvance • phone 259�8810. <br />2, All vrork shall be peAormed In accardence wlth this permit and curtent Ciry of Everett Desiqn and Conatruclion <br />Sta�darda and Specificationa <br />3. Cell Location Underyround Service 48 hra. before you dip. TOLI FREE NUMBER 1•800-424•5 . <br />INITI�L INiPECT10N <br />.. , .KIAK �RO � ED Mit <br />Pua� � 9'� <br />DATE eY J <br />OATE � � <br />�° <br />Approved lor Conalruction Date <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreel <br />Everat4 WA 98201 <br />Phone: 259•8810 <br />�e <br />� <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/epplicant hereby agrees to hold and save harm- <br />less the City ot Everett from eny en0 all claims for damages, costs, <br />ezp@n9B& Of CAUSe9 Of action that may eriae beceuae ol installalion <br />and maintenance of the improvement or other righFohway use harelo <br />app�ied lor and lurther agrees to remove same upon notice Irom the <br />City and to replace public property demaged Ihereby. <br />Date <br />Signature of ApPlicant <br />BORDAYS OFRDATE PERMIT ISEISSUED AND THEREAFTER ISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />PROJECT OVER 90 DA S DURAT ON. STOPPAGE OF WORK ON THIS <br />