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APPlication For <br />PUBLIC 1. ORKS PERMIT Da <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street Public Works Permit # <br />Everett, WA 98201 259-8810 <br />Building Permit # <br />TYPE OR PRINT ONLY —� <br />Public Works Fee $ <br />Plan Check No: C 516637 iy �CvLLNCj,6E Applicat.Date: <br />Owner Job Address: =1-4-21ST S —32 1 S,1ti <br />Owner: ENCE Phone <br />Tenant: <br />Proposed Use: DUPLEX <br />Applicant Desc. of Work: <br />ADDITION, NEW ROOF, REMODEL BATH & LAUNDRY Phone <br />Describe Proposed Work OFFICE SET <br />— _JOB SET <br />APPROVED FOR PERMIT: DATE_j_j_ BY W <br />PROJECT ADDRESS (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: m <br />'Property Lines 'Outline and dimensions of all existing and proposed structures on the lot *Existing and proposed utilities <br />•Centerline of street •Indicate North 'Show any proposed grading changes -Show measurements O <br />DO NOT WRITE BELOW THIS LINE PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. Z <br />2. All work shall be performed in accordance With this permit and current City of Everett Design and <br />Construction Standards and Specifications. O <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5585. L <br />i <br />No Hu6�,c %0(kS Perm', � C4 <br />l2A- I Y ('(Cep-- S/`7%1 Co 0 <br />am <br />Qoi6 '. ��� I /Z�c�C S ;cue S2c . e✓ f rvt 2G+ U LPL <br />W � Z�1 �� on cope rs s ; <br />�� s lam, I+ w�rl <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ate <br />TER IS TO BE DILIGENTLY PURSUED ISSUED AND THEREAFTER <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />