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�1 <br />. <br />!>_ <br />lJ i <br />Date9454 2. <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />reew�y` <br />1 Pubk Woik.Permn • <br />Slag D.m . 92/35561 <br />Public WPMF Fes <br />TOM F.. •� <br />Le., Mot pro Paid • _. <br />e.4ncx D�6 <br />Larry McCauley PO Box e87 Lk Stevens, WA 98258 355-2079 <br />Owner Meiling Address City Zip Phone <br />Owner <br />Applicant <br />Address <br />Zip Phone <br />Describe Proposed Work _Convert existing SFR to duplex (arid 2nd living unit to SFR) <br />LU <br />Project Address fit known) 10 T - 40 h Af aW <br />Istax- <br />Attach four (4) copies of plans for proposed work • Drew to scale and nnle the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline rind dimensions of all existing and • Indicate North v <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements wA <br />DO NO1 WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hra. In advance • phone 259.8810. F� <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and ConStruclicn i <br />Standards and Specifications. <br />3. Call Location Underground Service 48 his. before you dig. TOLL FREE NUMBER 1.800.424.5555. z <br />�B 21h1f2 V <br />Cl) <br />Approved lot Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />0 PUBIC WORKS DEPARTMENT <br />3200 Cedar Street <br />ff Everett WA 98201 <br />Phone: 269.8810 <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 bother agrees to remove some upon notice from 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 />