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Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257-8810 <br />TYPE OR PRINT ONLY <br />Owner <br />Applicant <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />DL . <br />Public Works Penult It <br />Building Permit 0 <br />Public Works Fee $ - <br />Plan Check Not B 66/2566/Phone <br />1 SEPA <br />ApJcAddreset 9192112TH ST BE <br />ob <br />Owners COLE FRED <br />Tenants Phone <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Works <br />ADDITION TO LIVING ROOM <br />OFFICE SET JOB SETS <br />APPROVED FOR PERMITt DATE_/_/_ BY <br />Attach tour (4) cooles plans for proposed work - Draw to scale and note the following If applicable: <br />• Property Lines • Outline and dimensions of all existing and proposed structures on the tot • Existing and proposed utilities <br />• Centedine of street • Indicate North • Show any proposud 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 accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifi. alions. , <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424-5555. <br />1tiLIC WOIgKS PERM" <br />h01 aulR>:r <br />ItY-� — /-�---�. <br />9AT--- <br />E...W�/Q^=- <br />Approved for cons ruc ion a e <br />FINAL INSPECTION Date <br />Approved as Constructed <br />z <br />0 <br />Y/ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownertapplicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may edge because of Installabon and maintenance of the <br />Improvement or other dght-of-way use hereto applied for and further agrees to <br />remove same upon notice from the City and to replace public property dam- <br />aged thereby. <br />Signature of Applican Lisle <br />WORK D THEREAFITR IS TO HE <br />OMFLETION. THIS PERMIT MAY DE CANCELLED BY THE crry UPON ANY STOPPAGE OF WORK ON T MSY ���� <br />PROECT OVER 90 DAYS DURATION.� u <br />