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Date <br />qpplication r'or <br />PUBLIC VUORKS PERMIT <br />Plan Check No: a 48504 SEPA <br />Print or Type Only Applicat.Date: 06/05/95 <br />Job AdOwner: 9UMPASSTEARLE W <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Owner Pesc. of Work: <br />CARPORT/SHOP <br />. � ApP�icant <br />Describe Proposed�Nork _ <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_�__ BY <br />Pu01ic Wo�ks Permii a <br />uieq. oco� • <br />Public Works Fea �, <br />Tolal Fee <br />Lesa AOD� Fee PaIE g <br />BalanceDue g <br />Zip Phone <br />Z�p Phone <br />Project Address (if known) — <br />Attach four (4) copies ot plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions ot all existing and <br />proposed structures on the lot <br />• Existing and proposeo ulililies <br />• Genterline ot street � <br />• Indicate North <br />• Show any proposed greding changes <br />• Show mexsurements <br />PERM�T CONDITIONS <br />1. All calls for inspeclion shall he made 24 hrs. in advance • phone 259-8810• <br />2. All v+ork shall be performed in accordance with this permit and current City of Everett Design and Conslrtictlon <br />Standards and Specitications. <br />�. Cal� Location Underground Service 48 hrs. be(ore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />��L�����I? � � �� <br />� �� �� S �(%YMi �� %�G v� r'�" <br />/Z �'"" ��,C� - <br />(�//G/I.j <br />Approved lor Construction <br />FINAL INSPECTICN Dale <br />qpproved as Construcied <br />�"' PUBLIC WORKS DEPARTMENT <br />3200 Cedar Streel . <br />Everett, W� 9Fi201 <br />Fhone:25��8870 <br />� <br />� <br />ACKNOWLEDGEMENI" OF CONDITIONS <br />The undersigned owner/aH; licant hereby agrees to hold and save harm- <br />less the Ciry of Everett irom sny and all ciaims for damages. costs, <br />expenses, or causes of aclicn .hat may arise because uf installation <br />and maintenance ot the improvement or olher ri��hl-oFway use hereto <br />applied (or ard further agrer.�s to rem�ve same upon notice from the <br />Ciry and to reVlace public prc,�erry damaged G�ereby. <br />Date <br />Signature ol APPticant <br />gORDAYS OFRDAT�E PERMIT ISEISSUGD ANDBTHER[AFTER ISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CIlY UPON ANY STOPPAGE OF WORK ON 7HIS <br />PROJECT OVER 90 DAYS DURATION. <br />