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Applicatfon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work _ <br />Project Address (if known) <br />Plan Check No: <br />Applicat.Date: <br />Job Address: <br />owner: <br />Tenant: <br />Proposed Use: <br />Desc. of Work: <br />STORAGE BLDG <br />OFFICE SET <br />B 47911 <br />03/31/95 <br />1415 50TH ST SE <br />RERGER PAT <br />GARAGE/SFR <br />JOB SET <br />SEPA <br />APPROVED FOR PERMIT: DATE�/_/_ BY <br />Puolle Works Pvmit s <br />01�0. D�Ot � �_ <br />PuEI¢ Worka Fas <br />ToialF�a S <br />Leff ApOI F�t Paltl Z <br />Balsnce �ve S <br />Z'P Phone <br />Z�P Phone <br />Atiach tour (4) copies of plans for proposed work- Draw to scale and note the teilowing as applicable: <br />• Property Lines • Centerline of slreet <br />• Outline and dimensions af all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurer,�ents <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. fn advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and cu�Tent City of Everett Design and ConstNction <br />Standards and SpeciHcatlona <br />3. Call Locatfon Underground Service 48 hra before you diy. TOLL FREE NUMBER 1-800-424-5555. <br />�'UBLiC WORKS PE��; <br />�7 REOUIREp <br />nv <br />n nTe `/ s�—"'"" <br />----_� <br />Approved for Construction Date <br />FINAL INSPECTION Dale <br />.4pproved as Consiructed <br />���I�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everelt, WA 98201 <br />Phone:259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/appli�ant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of lhe improvement or other ri�hbo(•way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br />BE DIIIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY'JPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />