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Date_ <br />( <br />.4pplfcetlon For <br />PUBLiC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: C 44356 <br />Applicat.Date: OS/11 94 <br />Job Addreas: 8421 TH AVE SB <br />Owner �ner: CARP IOAN <br />Tenant: <br />AppiiCant <br />Descr �s Proposed Work _ <br />Project Address (if known) <br />SEPA <br />Propoaed Use: SINGLE FAFIILY RESIDENCE <br />Deec. of Work: <br />ADD 1002SF CONDITIONED PLUS 2 CAR GARAGE <br />GUWb Worlu PumN • <br />BIEp. U�pt � _ <br />Pu01i�: Worlu FN <br />To1sl Fn s <br />Lw AppL Fw Pab S_ <br />B�4M� Ou� i <br />!ip Phone <br />:iP <br />OFFICE SET JOH SET <br />APPRO'✓ED FOR PERMITs DATE_/_/_ BY <br />Attach four (4) copies of plans for proposed work • Draw to scale and note Ihe following as applicable: <br />� Property Lines <br />• Outline and dimensions of all exisiing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />s Cenlerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for fnspection shall be made 24 hrs. in advance - phone 259•881 O. <br />''I work ahall be pedormed in accordance with this permit end current Cfty o� Everelt Deaign and Constructlon <br />�tandards and Spec(flcatlons. <br />3. Gall Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424-5555. <br />/l.E' G i Su' / / /%74-LL/..us-(� �7i 1/-CY:� S/�=Gc.Y, v •-G/irr-OfG`�y� <br />,V"�..[.e�Ct.-(/ .C� '�PJ;�`- ��iC�'Gt-.-`./lti�. -,/ Ln�.c% /IF�i'i.2C��vzG-�Y <br />O � �1 <br />PUBLIC WORKS PERMIT <br />NOT REOUIRED <br />BY � <br />DATE � �� %� <br />Approved lor Construction <br />F�NAL lNSPECTION <br />Approved as Constructed <br />�Ar�PUBLICWORKSDEPARTMENT <br />3200 Cedar Street <br />EverelL WA 98201 <br />Phone:259-8810 <br />Date <br />Date <br />ACKNOWLEDGEMENT OF CONCITIONS <br />W <br />H <br />� <br />� <br />O <br />The undersigned owner/applicant hereby eprees to hold end save harm• <br />less Ihe Cit/ ol Everett Iram any and all claims for dameges. costs, <br />expenses, or causes of action tnal may arise hecause af inatallatlon <br />and maintenance of ihe improvement or other right•ol•way use hereto <br />applied for and furiher agrees to remove same upon notice Irom the <br />Ciry and to replace public property damaped thereby. <br />Signatura of Applicant Dale <br />WORK AUTHOFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />pqfl.IFf.T f1VFR �(1 f1AYS DIIPATION. <br />