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�� .. �� PubMeNM�bP�rmM• <br /> Date - �n.nc. <br /> Applfcatlon For <br /> PUBLIC WI�RKS PERMiT °"°"`""°'"'`" <br /> Tottl FN � <br /> �p Appl FN P�iE � <br /> B�WwDw f <br /> Print or Type Only <br /> Plan Chack Nos C 41888 SBPA phons <br /> ]1pp11cat.Data: 09/O1/93 �P , <br /> Owner Job Address: 85b1 6TH AVE SE <br /> Ownors HAN30N RONALD <br /> Tenant� <br /> Proposed Uoe: SINGLB F1IMILY RESIDENCE ip Phone <br /> Applicant Da�c. of Wozk: <br /> KITCHBN/2 BSDROOM ADDN <br /> Describe Propoaed Work _ OFFICE SBT JOB SST <br /> APPROVED FOR PERHIT: DATS_/_/_ HY <br /> W <br /> Project Address(if known) � <br /> � <br /> Attach four(4)eopfes ol Ptaas for proposed work• Draw to scale and nate the lollowing as applicable: � <br /> • Property Lines • Centerline at street <br /> • Outline and dimensions of ell ezisting and • Indicate NoAh <br /> proposed slructures on the lol • Show any proposad grading chanpes <br /> • Exlsting and proposed utliities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calis for inapectlon shall be made 24 hrs.in edvence-phone 259�8810. <br /> 2.All work shall be peAormed in eccordence with thla parmit and curtenl Clty of Everett Desipn and Conatrudlon <br /> Stendarda and Speclticationa � <br /> 3.Cell Location Underground Service 48 hrs.before you dia TOLL FREE NUMBER 1$00�4245555. <br /> O <br /> , . � <br /> �'UBLIC WORKS PERM17 N <br /> NOT REOUIRED O <br /> 8V ✓ � <br /> DATE 9 � � 3 -- a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/epplicanl hereby agrees to hold and seve h&rm- <br /> less the City of Everett from any and all clalms for demage& costa <br /> � eapenses, or causes ot action that may arise bscauae of fnstalletion <br /> and malntenance ol lhe improvement or other riqht•of•way use herata <br /> applied for and fuAher agrees to remove same upon notice from the <br /> Approved for Consiruction �81e City and to replace public property dameged thereby. <br /> FINAL INSPECTION Date Date <br /> Approved as Consiructed Signature 01 Applicanl <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ,�� PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLEiION.THIS PERMIT MAY BE <br /> 1 <br /> Everett WA 9820t CANCELLED 9Y THE CITY UPON ANY STO?PA�E OF WOFK ON THI <br /> Phone:259�8810 PROJECT OVER 80 DAYS DURATION. <br />