Laserfiche WebLink
Date-- <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Chesil; No: C 44479 SEPA <br />Applicat.Da`e: C15/25/94 <br />Job Ad;,re: 920 90TH ST SW <br />O.vner: RUSNAK JEFFREY/DEBBIE <br />Owner Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Deac. of Work: <br />HOUSE ADDN <br />Appllca,,: <br />JFFICE SET _JOB SET <br />Describe Proposed W, APPRVD FOR PERMIT; DATE_/_/— By_ <br />Project Address tit known! <br />Pueec works Perms 0 <br />Bide Den l - <br />Public Works Fee <br />Total lee 'S <br />Leff A001 Fee Pud S <br />Balance Due S <br />p Phnne. <br />--- Phone <br />Attach lour (41 copies of plans for proposed work - Draw to +Odin ano note the following as anofirable.. <br />• Property Lines • Centerline nl 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 />1. All calls for inspection shall be made 24 his. In advance • phon: 259.8810. <br />2. All work shall be performed in accordance with this permit and turn City of Everett De_,gn and Construction <br />standards and Specifications. <br />3, Call Location Underground Service 48 hrs. before you dig 1OLL Ft E NUMBER 1.800.424.5555. <br />PUBLIC WORKS PERMIT <br />NOT REOUIREn <br />9y <br />uATE 9Y <br />W <br />IME <br />CI / <br />ca <br />•0 <br />Z <br />0 <br />rFm <br />Y <br />0^ <br />am <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owneNapplicant hereby anrees to hold and save harm- <br />less the City of Everett from any and all claims for damagescosts. <br />expensesor causes of action that may arise because of installation <br />-- - and maintenance of the improvement or other ngt+ot-way use hereto <br />i arN-ed 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 Date <br />Approved as Constructed <br />IVPUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 9B201 <br />Phone: 259-8810 <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 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 />