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Date <br />Applicalion F�r <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />owner <br />AppGcanl <br />Deacri6e Proposed Work <br />P.olecl Address (il knownl <br />Plen Check No: B 49626 SEPA <br />App licet.Date: 0'� 29 95 <br />Job Addreee: 2. 9 TH PL SE /E <br />Owner: HOUSING AUTYOR:TY OF EVT <br />Tenent: <br />Propoeed Uees NEIGHBORHOOD ASSOC OFFICE <br />Deec. of Work: <br />ADDITION TO REC BLDG <br />OFFICE SET <br />SET <br />Puebc wo,b Pe.mn . <br />B�Cp Dapl � _ <br />P�e�ic Wor�� (ee <br />to��� ree a <br />Uu �po� fee PnE S <br />Baiance O�e S <br />Phonr, <br />Phone <br />APPROVED FOR PEPr. 't DATE_/_/_ BY _ _ <br />Altech lour (4) copies ol Dlans lor proposed work � OraM� lo scaln an0 note the foilowing as apU��wGie: <br />� Property Lines • Cente�line oi slreet <br />• Outline and dimensions ol ull exreting and • Intlicale North <br />proposetl siructures on Ihe lot • Show any proposecf gratling chanqrs <br />• E�isting end p�oposeA utllihes • Show measurements <br />PERMIT CONDITIONS <br />1. All cells for inapectlon ahell be madA h�s. In edvance- phone 259•8810. <br />2. All woik vhell � e pedormed In eccordance with thia permit end current Clly of Everett Desiqn and Constructlon <br />Standarda ard Specilicetlons. <br />�. Call Localic�n Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•B00•42�•5555. <br />'UPLIC WO�K6 Pfi�MI, <br />",O t qFOUTAiD <br />'Y �� _ <br />•ATF.,�� 3 %S <br />, /.. _ �.._ .. <br />Approved loi Conatruetion Da1e. <br />FINAL INSPECT�ON Date <br />A�pro• ed es Construcled <br />��PUBLIC WORKS DEPARTMENT <br />3200 Ceder Sl�eet <br />Everett, WA 98201 <br />Phone�.259�8810 <br />W <br />H <br />V I <br />�� <br />� <br />� <br />v <br />� <br />� <br />O <br />a <br />ACKNOWLEDfiEMENT OF CCJN01}�IONS <br />The underslgned ownedapplicavt he�eby egrees t0 holA end save harm� <br />less Ihe Gty ol Ev�relt I�om nny and all claims ir� damages. r.osl� <br />expenses. o� causes af ar.tion Ihat mev ense btc&use ol Installah.m <br />and mamlenance ol ihe imp�a•einent o� othei ��bh6oF•.vay use hr.rc: � <br />appi�ed �or and lurlher agrees lo remove �:ame �, ��, n: hcr. 6om P- <br />G!y anA to replace public properly damagntl t'ier6oy. <br />Signalure cl N�P���anl Ualr. <br />WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br />IBG DAVS OF DAIE PERMITIS ISSUED ANU THEREAFTERIS TO <br />BE DILIG[NTLY PURSUED TO COMPLE11qN �1NIS PGRMIT M1V BE <br />C4NCELLP.D BY TH[ CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PRUJ[CT OVER 90 DAVS DURATION <br />