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LUdte_ /14 <br />Application For <br />PUBLIC;, WORKIS PERMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />Pro;, ct Address (If known) <br />Plan Check NO: C 37960 SEPA <br />Applicat.Date: 09/09/92 <br />Job Addra: 914 90TII ST SW <br />Owner: CLEMETSON, LEE <br />Tenant: <br />Proponed Use: SINGLE FAMILY RESIDENCE <br />Deac. of Work: <br />SFR ADDITION 598 SF <br />OFFICE SL�T JOB SET <br />APPRVD FOR PERMIT: DATE_/_/_ BY <br />Public Winks Perin . <br />Bldg Devi <br />Public Works Fee <br />Tabs Fee f <br />Less appl. -ee Paid S <br />Balance Due S <br />Zip Phone <br />Zip Phone <br />Attach four (4) copies of plans proposed work • Draw to scale and note the follow rig as applicable: <br />• Property Lines • Centerlne 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 • ^how neasnrements <br />PERMIT C014DITIONS <br />1. All calls for Inspection shall be made 24 hrs. In advance • phone 259•F810. <br />2. All work shell be performed In accordance with this permit and c.urant City of Everett Design and Construction <br />Standards and Speci4catlons. <br />3. Call Location Underground Service 48 hra before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />1'9U b4i W(7 -- ,i`Z�,,e- �v /VQeGvIL%9 <br />Approved for Construction Data <br />FINAL INSPECTION Date <br />Approved is Constructed <br />JUM77PUBLIC WORKS DEPARTMENT <br />- 32IX0 Ceder SVee1 <br />Everett, WA OF 201 <br />Phone: 2 in 9810 i <br />ACKNOWLEDGEMENT OF CONDITIONS <br />z <br />0 <br />H <br />0 <br />a <br />The undnaigned owner 'applicant hereby agrees to hold and saga -,arrm <br />less find City of Everett from any and all claims for damage--, coaLk <br />tcpenses, or causes of action that may arise because of Installr'+on <br />rind maintenance of the improvement or other right-of-way use h. .r. <br />applied for and further agrees to remove some Orlon notice fron its <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />%,'ORK AUTYORIZED B THIS PERMIT MUST FE STARTEP WITHIN <br />11`0 DAYS OF DATE PL'AllT IS ISSUED AND THEREAFTER IS TO <br />BE OILiG1.NTLY PURSULO TO COMPLETION. THIS PERMIT MAY BE <br />CANC, LFD UY THE CITY L';'ON ANY STOPPAGE OF WORK ON TtbS <br />PROJ6L.T OVER 90 DAYS I' )RATION. <br />