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Date_ <br />Aoplicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />Project Address 0f known <br />Plan Check No: B 44972 <br />APcAddress: 118131/ <br />94 <br />Job 73RD ST SE <br />Owner: MEDOFF ELICIT A <br />Pubhe Worka lee,mrl a <br />slag pool, e <br />Public WOrae Fee <br />Toter Fee S <br />LOSS APO Fee Paid S <br />Balance 0.6 $ <br />SEPA Phone <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Work: <br />NEW CARPORT, GARAGE, SUNDECK <br />OFFICE SET JOB <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Attach lour (41 Copies of plans for proposed work • Draw to srala 4na note the rollowmg as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the In' • Show any proposed grading changes <br />• Existing and proposed utllitlet • Show measurements <br />LOW <br />i <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 accordaeee 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 />Approved for Construction <br />INITIAL INSPECTION <br />PAUL McKEE <br />PUBLIC WORKS PERMIT <br />NOT BEOUIRED <br />Dy <br />fiATE �� 7 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />Fm <br />s/ <br />M <br />O <br />n <br />z <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm. <br />-- --" j less the City of Everett from any and all ctaima for damages. costs. <br />expenses. or causes of action that may arise because of installation <br />• -j- and maintenance of the improvement or other right-ol•way use hereto <br />applied for and further agrees to remove same upon notice from the <br />Dote Clly and to replace public property damaged thereby. <br />FINAL INSPECTION Date <br />Approved as Constructed <br />IVPUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Signature 01 Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AKIO 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 />�•.n •-�. n.•en e^, nwc nl10ATInN <br />