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i"rplication For Date. <br /> G,✓� PUBLIC �.ORKS PERMIT <br /> �(� PUBLIC WORKS DEPAFiTMENT public Works Pertnit N <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-BB10 8uilding Permil N <br /> Public Works Fee$ <br /> TYPE OR PRINT ONLY <br /> Plapn Check No: B 5/372/4 SEPA <br /> - N APJobCAddrese: 5410 25TH AVE W Phone <br /> � Owner pi,�ne=: COUNTRYWOOD HOMES <br /> Tenant: <br /> Propoeed Uee: SINGLE FAHILY AESIDENCE phone <br /> Applicant N Deec. of Work: <br /> DECK ADDZTION <br /> Describe Proposed Work OFFICE SET JOB SET � <br /> APPROVED FOR PERMIi: DATE�/_I_ BY � <br /> N <br /> PROJECT ADDRESS(if known) � <br /> , Attach four(4)copies of plans for proposed work'Draw to seale and note the tollowing if applicable: O <br /> •PropertY L1nes 'Outline and dlmensions of all axisting and proposed struclures on the lol •Exlsting and proposed utilities � <br /> �Centerline of street •Indicate NoAh •Show any proposed grading changes •Show measurements <br /> DO NOT WRITE BELOW THIS LINE �) <br /> �� <br /> PERNlIT CONDITIONS: O <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. � <br /> 3. Call Location Underc�round Service 48 hrs. before you dig. TOLL FREE NUMBER 7-800-424-5555. � <br /> O <br /> a <br /> ���No�qic�w��Pid�� <br /> �..'..,s-�^ . <br /> �X �+��L�::_� <br /> lA1C�•-�^�' <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appllcant hereby agrees to hold os�s exe enseseor <br /> the City ofi Everetl from any and all claims for demages, P <br /> causes of action that may arise because of instellation and maintenance oi <br /> ApprovedtorConstruction Date theimprovementorotherrighFoi-wayuseheretoappliedforandfurlheregrees . <br /> to remove same upon notice from the City and to replace public property <br /> damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Date <br /> Signature of Applicant <br /> COMPLErION.TIH S PERMIT MAY BE CANCEB ED BY THE CINfUPON ANY STOPPAGE OF WORK ON THIS PROJEC OVER 90 DAYS DULRATIONLY PURSUED TO <br />