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Date----- <br />App!IaI," n. <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: B 40593 SEPA <br />Applicat.Date: 05613/93 <br />Job Address: 62 61ST ST <br />Owner: DENNISON RICKIE K <br />Owner Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Work: <br />WORKSHOP STORAGE <br />Applicant <br />OFFICE SET JOB SET <br />Describe Proposed Work _ APPROVED FOR PERMIT: DATE_/_/_ BY <br />Project Address Ql known) <br />PublIC WorFe Failed <br />B" 0.01 e <br />Pobla Worru Fee <br />TOW he S- <br />Late spat Fee Paid S <br />Salem* but S <br />Attach lour (4) copies of plans lot proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All tails for Inspection shall be made 24 hrs. In advance - phone 259.8810. <br />2. All work Shall be performed In accordance with this permit and currnnl City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs belore you dig. TOLL FREE NUMBER 1.800-424.5555. <br />'� ease <br />� �� <br />PUBLIC WORKS PERMIT %c <br />NOT REOUIRED 1)"9 <br />eelta ee,, B Y—_-C.I� <br />DATE B__ 23. <br />...a1z <br />eey ,ems <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 <br />CedaEverett, <br />Street <br />ii%Ev <br />..�✓✓� Everalt WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />e <br />M� <br />M <br />O <br />n <br />z <br />O <br />FM <br />/� <br />W <br />0 <br />an <br />The undersigned owner/applicant 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 of Installation <br />and maintenance of the Improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />I <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />