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-� /�� � _ <br /> Date <br /> Public Worka Permil• <br /> Application For eiao.oeo�.a <br /> PUBLIC WORKS PERNiIT PubTolalFeeFce $ - <br /> Less Appl.Feo Paitl $ <br /> Print or Type Only BelanceDue S <br /> � Owner Plan Check No: C 41925 SEPA � phone <br /> Applicat.Date: 09/03/93 . <br /> Job Address:,__1306_ lOTH_ST_ <br /> Owner: ALLEN-LEE J <br /> Applicant Tendnt: <br /> Proposed Use: SINGLE FAMILY RESIDENCE Phone <br /> Desc. of Work• <br /> UTILITY RM / FAMILY RM ADDN <br /> Describe Proposed Work <br /> OFFICE SET JOB SET <br /> APPROVCD FOR PERMIT: DATE_�_�_ BY <br /> W <br /> Project Address(if known) � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and no!e the followiny as applicable: �� <br /> • Property Lines • Centerline of street � <br /> • Oudine an�J dimensions of all existing and i Indicate North � <br /> proposed structvres on the lot • Show any proposed grading changes <br /> • Existing and prcposed utilities • Show me2surements � <br /> DO NOTN;RITE BELOW THIS LINE <br /> PERMITCONGITIONS O � <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259-8810. � <br /> 2.All work shall be performed in accordance v+ith this permit and 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•$00-424-5555. � <br /> .. � <br /> pUBI.IC WORKS P�RMIT � <br /> NOT EQUIRED ♦^ <br /> eY V♦ <br /> DATE `� c5� y� O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applir.ant hereby agrees to hold and save harm- <br /> less the Ciry of Everett irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because ol installation <br /> and maintenance of the improvement or other right-of-way use hereto <br /> applied for and Nrther agrees to remove same upon notice from the <br /> Approved lor Construction Date <br /> City and to replace public property damaged thereby. <br /> FItJAL INSPECTION Date <br /> Approved as Constructed Signature of Applicanl Dale <br /> PUBLIC WORKS DEPARTMENT WORK AUTI10RI2ED BY THIS PERMIT MUST BE STARTED WITHI(V <br /> 3200CedarSireet 780 DAYS OF DATE PERMII" IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 2E <br /> Phone:259•BB70 CANCELLED BY THE CITY UPON ANY STGPPAGE Of WORK UN THIS <br /> PROJECT OVER 90 DAYS DUNATION. <br />