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CApplkaUon For <br />� PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />e�ere��, wase�o� �a2s� 2s�•ee�o <br />TYPE �JR PRINT ONLY <br />Owner <br />Applkant <br />Describe Propesed Work <br />Plan Check No.: <br />lob Address: <br />Owner: <br />Tenant: <br />Applloqon Date: <br />r'roPosed Use: <br />Type of work; <br />C9909-005 <br />1902112TN 5i SW <br />MINGE]ASON <br />Y/7/99 <br />SFR <br />ADDITION <br />Office Set---_ ]ob SM Fire/Planning SM <br />APProved For Permk• Dabe: gy; <br />PROJECT ADDRESS (II known) <br />�e�d <br />Public Works Permlt M <br />Building Permit k _ <br />rubnc works Fee a _ <br />Phone <br />PMne <br />Attach lour (4) toplet plene lor proposed vrork • Drew to ecate end note tha fo�lowinp II epplkable: <br />• Property lJnea • Outline end dlmenslone ol ell exletinp end propaeed structurea an tl�e lol • Exlellnp erM propnsad utilillee <br />• CenleAlne of sheet • IMicate Nortl� • Show eny propoeed predinp changes • Show moaeurementa <br />DO NOT WRITE BEIOW THIS LIIJE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be madd 24 hours in edvance - phone (425) 257-80 � � <br />2. All work shall be performed in accordance w�'ti this permit end current City ol Everetl Design and <br />Construction Slendards end Specflicatlons. , <br />3. Cell Location Underground Service 48 hrs. belore you dig. TOLL FREE NI�MBER 1•800-424-5555. <br />'•U➢LIC WORKS �EPMI � <br />NOT �,/{/�OUTAE� <br />�Y._— —`�,V1 <br />•ATF.�-- -.��� <br />pprove �or ns ruc ion e e <br />FINAL INSPECTION <br />Approved es Conahucted <br />Dete <br />� <br />O <br />'�^ <br />V/ <br />� <br />a <br />ACKNOWLEDOEMENT OF C6NDITIONS <br />The untlenlgned ownerlapplicant hereby apreee lo Iaid arM seve harmleee <br />the Ciry ol Evarett Irom eny and ell clalms lor demapea, coa4, expeneea, or <br />cauees ol ectlon Ihat may erlse becauee of Inetellatlon end meintenanr,e al the <br />Improvement or otl�er rlphtol-wey uea herero epplled lor and lurthe� eproae W <br />remove eame upon nodce Irom Ihe Ciy and lo roplece public proparry dam• <br />eped Ihereby. <br />Slpne ure o picanc a e <br />WOHK AUT110R�D BY THIS PERMR MUST BE STARIED WfT1iIN 1B0 DAVS OF DAIE PERMR IS ISSUEDMID TYf�HEAFfER IS TO BE ORlOENTLY PURSUED 10 <br />OOMPLETION. THIS PERMfi MAY BE CANCELLED BY i}E CRY Ui'ON ANY 3R7PPAOE OF WORK ON TFqS PRO�CTOVER BO DAVS OURA710N. <br />