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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />DeacAba Proposed Work <br />Plan Check No: <br />Applicat.Date: <br />3ob Addreas: <br />owner: <br />Tensnt: <br />Propoeed Uee: <br />Deec. of Work: <br />NEW FOUNDATIO <br />C 38604 SBPA <br />11/04/92 <br />23z0 SUMMIT AVS <br />SMITH ICEVIN W <br />SINGLE FAMILY RSSIDENCS <br />N UNDER EXISTING / REMODEL <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/�I_ HY <br />PpDim Wo�k� Palmlt • <br />BIEp. D�D� • <br />hpl¢WOA�Faa : <br />TO��I iaa <br />Lau Apcl Fp P��a s <br />B�I�M� Du� s <br />Zip Phone <br />Zip Phone <br />Project Addrosa Uf known) <br />Att�c� four (4) copfes ot plane for proposed work - Drew tu scale end nole � Cenllerline ot tPeel�ble: <br />� PrapertY Lines • Indicate NoAh <br />• Outllne and dimenslona ol sll eziating and � Show eny propoaed 9radinp changes <br />proposed slructurea on the lot • Show measurementa <br />• Ezintinq and pro0osed utilitiea _ _ <br />pERM1T CONDITIONS <br />7. All ulle for inspeetlo� ehall be made 24 hra. In edvance • phone 259-8810. <br />2, All work ehall be psAormed �n eccordance with thie perm�t end curtent Clry of Ewrotl Deaqn and Conetruction <br />Shndarde and Speciticetiona <br />9, Cell Locatlon Underpround Sarvice 48 hra before you diq. TOLL FREE NUMBER 1-800�4245555. <br />PUB NOTW E�UI �p MIT <br />BY � — <br />DA7E �' p <br />ApprovedforConstructlon Date <br />FINAL INSPECTION Date <br />Approved as Constructod <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slr¢et <br />Everetl, WA 98201 <br />Phone:259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agreea to hold and save herm- <br />less tha City of Everetl irom anY and all claims lor damapes, coata <br />ezpenses, or ceuses of eclfon Ihet may arlse becauae of Installation <br />and meintenence ol the improvement or other Mg�Pof-way use hereto <br />applied tor end further agrees to remove same upon notice from the <br />City and to raplace public properry damaped Ihereby. <br />Signature of Applicant Date <br />BORD VSTOFRDATE PERMIT ISEISSUED AND TNEREAFTER ISHTO <br />BE UILIGENT�Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />