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I <br /> �,�.%�� 2-- <br /> Public Werke Pelma e <br /> Date. <br /> Bldg DePI a -- <br /> .Application For <br /> PUBLIC WORKS PERMIT P°b:o:FeeFee $ -- <br /> Leas APPr Fee Paid s— <br /> Balance Due `S <br /> F,int or Type Only <br /> Plan check Nos C 37014 SEPA <br /> Applicat.Dates 06/12/92 <br /> Owner Job Addres 315 76TH ST Zip Phone <br /> Owners HANSON, CHRISTOPHER <br /> Tenant: <br /> Proposed Use: SINGLE FAMILY RESIDEN(IF. <br /> Desc. of Work: Phone <br /> Applicant ADD FAMILY ROOM 6 HATH OVER EXISTINC GARAGE Zip <br /> Describe Proposed Work <br /> GFFICE SET JOB SET <br /> APPRVD FOR PERMIT: DATE_/_/_ BY <br /> _ W <br /> Project Address fit known) <br /> Attach four 141 copies of plans for proposed work• Draw to scale and Hole the following as applicable: <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • 3how any proposed grading changes <br /> • Existing and proposed utilities • Shnw measurements M <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEgMIT 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 /> ti <br /> 7�8 U r 7-9 z Ch <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS, <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the Cil/ of Everett from any and all claims for darnnges, costs. <br /> expenses, or causes of action that may arise because D 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 /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Dale - Date <br /> Approved as Constructed Signature of Applicant <br /> AUTHORIZEDWORK PERMIT <br /> PUBLIC S DEPARTMENT <br /> B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 15HTO <br /> 3200 Cedarder Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />