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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or lype Only <br />Owner <br />Applicant <br />Describe Proposed Worl <br />Project Address (It known) <br />Plan Check No: B 39583 SEPA <br />Applicat.Date: 02/17/93 <br />Job Address: 1405 73RD ST SE Zip <br />Owner: ERICKSEN ANDY 6 ANN <br />Tenants <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />De ac. of Work: Zip <br />320SF ADDN / 320SF CARPORT — FIRE DAMAGE <br />OFFICE SET JOB <br />APPROVED FOR PERMIT: DATE__/_/_ BY <br />Publm Wprke Permq <br />eieg Dept a __ <br />Ppbi¢ Wprke Fee <br />ToW fee S <br />Leek Appl. Fee Pug S <br />Belem 0oe S <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following 3s 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 />PERMIT CONDITIONS <br />1. All calls !or Inspection shall .�e made 24 hrs. In advance - phone 259.8810. <br />2 All work Lh,tll be performed In acc yrdance with this permit and current City of Everett Design and Construction <br />Standards and Fpecificatlors. <br />3. Cell Location Underground Service 48 hrs. before yoll dig. TOLL FREE NUMBER 1.800-424.5555. <br />IUBLIC WORKS PERMIT <br />NOT REOL'IRED <br />BY <br />DATE_ a �' 9-3 <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />WORKS DEPARTMENT <br />32DO L <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDIT1014S <br />LW <br />■ <br />ca <br />0 <br />no <br />4 <br />a <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 or installation <br />and maintenance of the improvement or other right-of-way use herelo <br />applied for and further agrees to remove same upon notice ',om the <br />City and to replace public property damaged thereby. <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 />