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I �,dte ^ Public Works Permii s <br />' � eiev�oeo�• <br />� Application For <br /> PUBLIC WORKS PERMIT PUOTOWFeeFee s <br /> Plan Check No: C 46435 SEPA LeseApO�FeePaiE S <br /> Applic8t.D8te: 12[12�94 BalanceDue S <br /> Print or Type Only Job Addre: 103u2 TH AVE SE <br /> Owner: VAt1 BEEK RICfIARD <br /> Tenant: <br />'I Propoeed Uee: SFR/GARAGE <br /> Deec. of Work: <br /> ADDITION TO SFR AND NEW GARAGE <br /> II Owner Zip Phone . <br /> OFFICE SET JOB SET <br /> APPRVD FOR PERMIT: DATE_/_/_ BY Zip Phone <br /> Applicant <br /> Describe Proposed Work � <br /> W <br /> Project Address(if known) � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ot street � <br /> • Outline and dimensions ot atl existing and • Indicate North <br /> proposad structures on the lot • Show any proposed grading changes <br /> • Exi�ting and proposed utiiities • Show measurements M <br /> W <br /> � DO NOT WRITE BELOY�THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspectbn shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAorm6d In accordance with this permit and current City of Everett Design and Construction <br /> Standerds and Specltications <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�4245555. � <br /> O <br /> �'UBLIC WORKS PEPJiA1T � <br /> �Of E�UIREII <br /> ay � N <br /> �.!AT E �� /1 fL O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/app�icant hereby agrees to hoid and save harm- <br /> less the City of Everell from any and all claims tor damages, costs, <br /> expenses, or causes of action thai may arise because of instailation <br /> �� and maintenance of the improvement cr other right•ohway use hereto <br /> applied tor and turther agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PEflMIT MUST dE STARTED WITHIN <br /> ���� PUBLIC WORKS DEPARTMENi 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CederStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> EveretL WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />