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Date <br />Application For <br />PUBLIC WQRKS P�RMII <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />Project Address (if known) <br />Plan Check No: B 46ti:i3 SEPA <br />Appiicat.Date: O1/25/95 <br />Job Address: 7430 17TH AVE SE <br />Owner: LEWIS CHAD/PATRICIA <br />T=nant: <br />Proposed Use: SINGLS FAMILY RESIDEtJCE <br />De�c. of Work: <br />ApDING ON ROOM <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DF.TE_/�/_ BY <br />-w' � I Pv01ic Wotks oermil a <br />Bltlp. Deo�. � <br />Pu�I��WorklFee � <br />Total Fco <br />Less AOGL Fee Paitl S <br />9tl3nce Dvc �u __ . _ <br />Z�P Phone <br />Attach four (4) copies of plans for proFosed work • Draw to scale and note the following as applicable: <br />• Properly Lines <br />• Outline and dimensions ot all existing and <br />proposed structures un ihe lol <br />• Existing and propused utilities <br />• Centedine ol street <br />• Indicate Nnrth <br />f Show any proposed grading changes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />7. Ail calls for inspection shall be made 24 hrs. in advance- phone 259•881 O. <br />2. AII work shall be pertormed in accordance with lhis permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dly. TOLL FREE NUMBER 1•800-424-5555. <br />"UBLIC WCRKS PEPMI'F <br />h� RFqUIREf) <br />' Y-_, fJ <br />; nr- z � 1� r <br />/ <br />Approved for Construction Dzte <br />FINAL INSPECTION <br />Approved as Constructed <br />������� PUBLIC WORKS DEPAHTIv1ENT <br />3200 Cedar Stme; <br />��'� Everel4 W° 98'201 <br />7_.. <br />Phone:259-88�0 <br />Date <br />AGF:NOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />Y/ <br />a <br />a <br />The undersigned ownedapplicant hereby agrees to hold ar�d save harm- <br />less the Ciry ot Everetl Irom any and ail claims tor damages, costs, <br />expen,es, or causes of action that may arise because of installation <br />and malntenanca ol the improvement or olher right-ohwap use hereto <br />applied tor and f�rther ayrees to remove same upon notice trom the <br />City ar.d to replace public property damaged lhereby. <br />Signalure ol ApPlicant Daie <br />WORK AUTHORIZED HY THIS PrRMIT MUST BE ST.4FtTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAI?ER I5 TO <br />BE DILIGENTLY PURSUED TO COMPL�TION. THIS PERMIT MAY BE <br />CANCcLLED BY THE CITY UFON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUAATION. <br />