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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />_ Plan check No: C 49430 SEPA <br />Owner ApSlicat.Date: 09/08/95 <br />Job AdOw7 TS <br />Owner: ABADJESSEGMENCH <br />Applicant <br />Describe Proposed Work <br />Project Address (if known) <br />PeblIC Wurke Pumlt <br />Bide Dept. <br />PUbllp Works Fee <br />Total Fee <br />Lets Appt Fee Paid S <br />Wence Dee $ <br />Tenant% <br />Proposed Uset SINGLE FAMILY RESIDEt:CE <br />Desc. of Work: <br />ADDITION — 2 BEDROOMS — AT BACK OF HOUSE <br />OFFICE SET JOB SET� <br />APPROVED FOR PERMIT% DATE_/_/_ BY <br />Attach four (4) copies of plans for prnP05ed work • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Ind!cate North <br />proposed structures on the lot • Show any propn3ed grading changes <br />• Existing and proposed utilities • Show measurements <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls 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 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. <br />:'UALIC WORKS PENMIT <br />t;Oi RF.CUU1Ern <br />►Y_ <br />IIATE_ T//_7 <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />CPUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 25!t-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />M <br />O <br />n <br />iZ <br />0 <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 />Signature of Apolicant Dale <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 00 DAYS DURATION, <br />