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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only Plan Check No: 9 42017 <br />Applicat.Date: U9/14493 <br />Job Address: 13 8 3RD ST SE <br />'twner: RICHARDS DAVID <br />tenant: <br />Proposed Use: SFR/DECK <br />Owner Devc. of Work: <br />NEW DECK <br />Applicant <br />Describe Proposed Work <br />OFFICE SET JOB SET_ <br />APPROVED FOR PERMIT: DATE__/_/ <br />SEPA <br />BY <br />P.M. Work. Permit e _ <br />otdg Dept. <br />P.bl¢ Work, Fee <br />Tow fee S <br />Le., APPt Fen P.rd S <br />Balance Due S <br />Phone <br />Phone <br />Project Address (if known) <br />Attach lour <br />(4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />• Centerlinc of street <br />• Indicate North <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Show any proposed grading changes <br />• Show measuremenls <br />DO NOT W'RI <br />TE BELOW THIS LINE <br />PERMIT CONDITIONS <br />O <br />1. All calls for Inspection shall be made 24 hrs. in advance <br />- 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. Cell Location Underground Service 48 hrs. before you dig. <br />TOLL FREE NUMBER 1.800.424.5555. <br />O <br />UBLIC WORKS PERMIT <br />NOT RFOUIRED <br />BY <br />)ATC - <br />Ch <br />O <br />a <br />16 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicano 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 />Approved for Construction Date <br />applied for and furthar ogrees to remove same. upon notice from the <br />City and to replace public pi nDerly damaged thereby. <br />FINAL INSPECTION Date <br />ARprovatl as Constructed <br />_ <br />Signature of App:;cant Date <br />JUM77PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />WC,1K AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />18( DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />Everett, WA98201 <br />BE DILIGENTLY PURSUED TO COMPLLTION. THIS PERMIT MAY BE <br />Phone: 259.8810 <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />