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Date 2 , rl <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check Not C 35679 SEPA <br />Applicat.Date; M18/92 <br />JJob Addrese24f21 1ST PL SE <br />Owner Owner: GRENIER, ROBERT <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Deer,. of Work: <br />Applicant ADDITION 184 SF <br />OFFICE SET JOB SET <br />Describe Proposed Work _ <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Project Address (it known) <br />Public Were. Parmlt <br />Old, o. l •3" &7 <br />Public Wbr.. F.. <br />TPI.I Fe. $ <br />Lea. APPI Fee Paid $ _ <br />e.l.nce Due $ <br />Ip Phone <br />Ip Phone <br />Attnch four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Properly 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 />I.All calls for inspection shall be made 24 hrs. in advance • phone 259.8810. <br />2. All work shell be performed in accordance with this permit and current City of Everett Design and Constr ctlon <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREC NUMBER 1.800.424.5555. <br />a.ue�t/�e�tfoG <br />1pproved lot Construcllon Date <br />'INAL INSPECTION Date <br />1pproved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259.6810 <br />I-i9-Re <br />Im <br />O <br />n <br />z <br />O <br />ch <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <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 of 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 />City and to replace public property damaged thereby. <br />Signature of Applicant wale <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 />