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Applicalion For 3 <br />PUBLIC WORKS PERMIT Oate <br />PUBLIC WORKS DEPARTMENT Public Works Penult 0 <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 i Building Permit a <br />U 9 2001 <br />TYPE OR PRINT ONLY TO POSTING _N0H ( Public Works Fee E 7�J <br />Owner <br />Plan Check Not• d 161'/68 % �r rw i' s SEPA <br />Appllcat.Date: 03/05/99 u� o <br />JJob Addreee: 19 5 3RD ST SE r <br />Owner: NGUYEN MY HIEN <br />Tenant: <br />Applicant M: Proposed Uset SINGLE FAMILY RESIDENCE <br />Deac. of Works <br />MASTER BED/BATH/LAUNDRY ADDITION AND GARAGE <br />Describe Proposed Work -- <br />OFFICE SET JOB SET <br />PROJECT ADDRESS (if known) <br />IAA <br />APPROVED FOR PERMIT: DATE _/_/ BY <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following If applicable: <br />Phone <br />Pho. is <br />'Property Lines 'Outline and dimensions of all existing and proposed stn,Lturos on the lot •Exisling and proposed utilities <br />-Centerline of street 'Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design ano <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-55M. <br />ue dr; ve�1LLrroM C lte edge <br />I <br />FINAL 114SPECTION Date <br />Appmved as Constructed <br />W <br />ca <br />0 <br />M) <br />z <br />0 <br />C0 <br />0 <br />a <br />.ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the Improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public pmpeny <br />damaged thereby. <br />Signature of Appll nt Dale, <br />WOHK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSJED AND THEREAFTER IS TO BE DILIGENTLY PUR'RIED '0 <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OV'n 00 DAYS DURATION. <br />