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Date � ' v�mmworkeve�mv. <br /> Application For BiEp.Deal.� <br /> PUBLIC WORi�S I�ERIVi�T Publm'NorksFee <br /> Tctal Fee s <br /> �eaa PpOI Fee PaiC S_____ <br /> Print or Type Only a.m��ao�a s <br /> P13n Check No: C 4<391 SEPA <br /> Applicat.Date: OS 15(5�. <br /> Job Addrees: 19 1 �6'?H ST (B) <br /> Owner Ownex': RED Ci205S <br /> Tenant: Zip Phn - <br />� Proposed Uee: <br /> Deec. of Work: <br /> REMODEL–KITCHEN�BATH�WINDOWS�PP.INT� DRYWALL <br /> Appiicant Z�p ,- � �— <br /> OFFICE SET JOB SET <br /> Describe Proposed Work pFPROVED FOR PERMIT: DATE_/_ /_ BY ,. <br /> _ -- - W <br /> Prolect Address(if known) ____ � <br /> Attach four(4)copies of plans for proposed work- Draw to 5cale and note the foflo•,ving as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and �! Indicate North <br /> proposed structures on the lot 4 Show any proposed grading changes <br /> • Existing and proposed utilities • Sho�v measu�ements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All �:alls tor inspection shall be made 24 hrs.in advance•phone 259-8810. � <br /> 2.All work shall be peAormea In accardance with th!s permit ar.d current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � <br /> � <br /> PUBLIC WORKS PERMIT � <br /> NpT REQUIRED <br /> BY ^� _ _ , O <br /> UATE �9 %'� <br /> - a <br /> ACKYOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> - — less the City of Eve�ett from any and all claims tor damages, costs, <br /> expenses, or causes of action that may arise because of instaliation <br /> and maintenance of the impruvement or other right•af-way use hereto <br /> Approved for Construction Date app:ied tor and further agrees lo remove same upon notice from the <br /> City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> PUBLIC WOR.(S DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CederStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretL WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259•8810 CANCELLED BY THE C�TY UPON ANY STOPPA6E OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />