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Tl'PE OR PRINT ONLY <br />Owner <br />Applicant <br />Describe Proposed Work <br />� <br />ppplicalion For <br />PUBLIC WORKS PERMIT <br />PROJECTADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257•8810 <br />( <br />Date <br />Public Worke Permit q <br />Building Permit # _ <br />Public Works Fee $ _ <br />Plan Check No: C 62319 SEPA <br />Appllcat.Date: 04/29/99 <br />Job Addreees 8536 $TH AVE W <br />Owner: TELLEFSEN TOM <br />Tenants <br />Propoeed Uee: DUPLEX <br />Deec. of Work: <br />CONVERT FROM SINGLE FAMILY TO DUPLEX <br />OFFICE SET JOB ^aGT <br />APPROVED FOR PERMIT.: DATR�/_�_ gy � <br />one <br />one <br />Atlach lour (4) copies plans lor proposed work • Draw to scale and note the lollowing il applicable: <br />• Property Lines • Outline and dimensions ol all existing and proposed structures on 1he lot • Existing and proposed utilities <br />• Cen'«.dine of street • Indicate Nodh • Show any proposed grading changes • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be performed in acccrdance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. , <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />'JliLlC N/ORKS �5Hri1d�� <br />(oOT j}�aUiR�.r <br />oY_.-�. d �:� <br />AATE__ �.��„��[�_� . <br />�� -1. h�1uS� �p ►��e -� n�ete red �e� Se,� v��,e <br />9 9 ,�� �. <br />Z, M�S.� �;Yh t�d ti�rmleas -�r' �'�^'' .7 r� <br />ppmve or onstrucnon ate <br />FINAL INSPECTION <br />Approved as Constmcted <br />Date <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />V ♦ <br />V <br />a <br />ACKNOWLEDGEMENT OF CONDITIOiJS • <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the Ciry of Everett from any and all claims for damages, costs, expenses, or <br />causes o( actlon that may arise hecause of installation and maintenance ot Ihe <br />improvement or other righPof•way use hereto applisd for and further agrees to <br />remove same upon notice Irom ihe City and to replace public property dam- <br />aged thereby. <br />igna ure o pp ican a e <br />WORKAUT}IOR�D BYTHIS PERMR MUST BE STAFiTED WIIHIN 180 DAYS OF DAT� PERMfT IS ISSUEDAND iHEREAFfER ISTO BE DILIGEMLY PURSUEDTO <br />CAMPLE�ON. THIS PERMfT MAY BE CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS PRQIECTOVER 90 DAYS DURATION. <br />