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�" <br />TYPE OR PRINT ONLY <br />Owner <br />Applicant <br />{ :ation For <br />PUBLIC WORKS PERMIT <br />Describe Proposed Work _ <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, Wq gB201 259-8810 <br />Plan Check No: S 57478 <br />Applicat.Date: 12/18/97 <br />Job Addreas: 10427 17TH PL W <br />Owner: LORIMOR ERIC <br />Tenant: <br />Proposed Use: SHED <br />Desc. of Work: <br />STORAGE SHED <br />OFFICE SET JOB SET <br />Date <br />Public Works Permit p <br />Building Permit p <br />Public Works Fee $ <br />SEPA <br />LOT 18 phone <br />APPROVED FOR PERMIT: DATG_/_�_ gy <br />Atlach four (4) copies of plans for pmposed work - Draw to scale and note the following if applicable: <br />'Property Lines •Oulline and dimensions of all existinq and proposad st�uctures on ihe lot •Existing and proposed utilities <br />•CeMerline of street •Indicate Nohh •Show any proposed gmding changes •Show measurements <br />ERMIT CONDITIONS: <br />--.. ...._ _..._ <br />1. Ail calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance with thi;, permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before ��ou dig. TOLL FREE NUMBER 1-800-424-5555. <br />�iJ4L1G yby�{hi Meni.�Y{-f <br />�•�or Flccuir���� <br />'''�'---� `_ �. <br />n.;Tr:_____,. � .� - <br />. __ ,._.., <br />Approved for Consiruction Date <br />FINAL INSPECTION ���e <br />Approved as Constructed <br />Z <br />O <br />/1�/� <br />V ♦ <br />� <br />o. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />ihe City of Everett lrom any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and mainlenance o( <br />the improvement or other righ4ol-way use hereto applied for and further ayrees <br />to remove same upon notice from lhe City and to replace public property <br />dama9ed thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZEC BY TfiIS PERMIT MUST BE STARTED WITHIN 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTI.Y PURSUED TO <br />COMPLEfION. THIS PEFMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />