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Date--2A/90 Pubkc Work,Permll• _ <br /> amv Dept •_4.Q/1SSa6 <br /> Application For <br /> PUBLIC WORKS PERMIT Pub <br /> elic Works <br /> Tote F.,Fee • <br /> Less Appl Fee Paid • I <br /> aelpncs nue S i <br /> Print or Type Only <br /> Mike Hoyden <br /> 329 - 60th St Pvkerpbr oa2na Ir 9;_11 <br /> Owner Mailing Address Cily Zip Phone i <br /> Mike Hoyden <br /> Applicant Mailing Address City Lip Phone <br /> Describe Proposed Work Reduce garage & use for bedroom space <br /> Project Address It known) <br /> Attach lour(4)copies it plans for proposed work•Draw to scale and note the following as applicable: <br /> • Property Lines • Centerfine of street <br /> • Outline and dimensions of all existing and <br /> Indicate North <br /> proposed structures the lot • Show measurements M <br /> • Existing end proposedd • Show any proposed grading changes <br /> utilities W <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hra.In advance•phone 259.8810. �\ <br /> 2.All work shall be performed In accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3,Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. z <br /> l <br /> /�(/� ,dja✓�ev-L C/1Pan.Z�;,s� �c�.G 72o�.C�.c' �qV <br /> I <br /> I, <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownertapplicant hereby agrees to hold and save harm- <br /> - less the City of Everett from any and all claims for damages, costs <br /> expenses, or causes of action that may arise because or installation <br /> and maintenance of the improvement or other righhol•way use hereto <br /> Applied for and further agrees to remove same upon notice from the <br /> Approved Im Construction Dale City and to replace public property damaged thereby <br /> i <br /> FINAL INSPECTION Date Dale <br /> � <br /> Approved as Constructed Signature T Applicant WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evernU PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMI' IS ISSUED AND THEREAFTER IS TO <br /> 1 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PhonE 259.8810 PROJECT OVER 90 DAYS DURATION <br />