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[�1 C>s1 � <br />�l y <br />YH[/� <br />H �� <br />�H� <br />'� M `�9 <br />Vl M <br />[�J O � <br />OH <br />��8 <br />� V �] <br />zH�yH <br />rHH <br />N <br />gdy <br />�c� r <br />H to <br />H O [�: <br />� <br />Date <br />qpplication For <br />PI;BLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: B 37352 SEPA <br />Applicat.Date: 07/13/92 <br />Job Ad�ner: OSTANTYCKENNETHL6CSHARON <br />Owner Tenant: <br />Propoeed Use: SINGLE FAHILY RESIDENCE <br />Deac. of ^�k� <br />ADDN 396 SF <br />Applica�t <br />OFFICE SET JOB SET <br />DescribeProposedl APPROVED FOA PERHIT: DATE_/_/_ BY <br />w� <br />v�e��c wo,�s am�,n . <br />e�aa oeoi • <br />PcEi¢Wo�ksfee S <br />Tiirl Fee <br />i.eu �ool Fee PUE 5 <br />eal�nce Oue = <br />Z�p Phone <br />Project Address (il known) <br />Attach lour (4) �op�es ol plans foi proposed work - Draw to scale and note the lollowin9 as appNcable: <br />• Property Lines • Cenledine ol streel <br />• Outlir.e and dimensions of all existing and • Indicale North <br />proposed structure:; on the lot • Show any proposed gratling changes <br />• Existing and propa;ed utilities • Show measurements <br />PERMIT CONDITIONS <br />i. All calls for inspe�.tion shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City ol Everett Design and Gonstmction <br />Standards and Specitications. <br />3. Call Location Undergro�nd Service 48 hrs. before you dig. TOLL FHEE NUMBER 1•800�424•5555. <br />� :�: r <br />� ���' � � �-�.�� : . � t` �.���.. �. ✓ � 4 ` J <br />�� <br />qpproved for Construclion Oate <br />FINAL INSPECTION Date <br />Approved as Conslnicted <br />��r�PUBLIC WORKS DEPARTMC-NT <br />3200 Cedar Slreel <br />Evcrelt, WA 90201 <br />P�one:259�88t0 <br />W <br />� <br />�w <br />_ / <br />� <br />O <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF CON�ITIONS <br />The unde�s�gned owneqapP�icant hereby agrees to hold and save ha:m� <br />less the City ol Everelt irom any antl all claims for Camages, costs. <br />exPenses, or causes ol action thal inay arise because o� installation <br />and mainlenance ol the improvement or other righl•ol-way use hereto <br />apPlied for antl further agrees to remove same upo� nolice irom Ihe <br />City and to repiace puhlic properry damaged thereby. <br />Signature ol Applicant Date <br />WOAK AUTHORIZED BY THIS PERMIT MUST 6E STARTED WITHIN <br />180 DAYS OF DATE PERMITISISSUED AND THE9EAFTERIS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WOFK ON TNIS <br />PROJECT OVER 90 DAYS DURATION. <br />