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fl <br />7/22/91 -� Public Work. Permde <br />Date aide 0.01 . 01 /27375 -- <br />Algrliralrnn for <br />H c7H PUBLIC WORKS PERMIT P°""Tot.Fee • <br />p r `4 Le.. eDPI faa PAW111 — <br />D ( y en.or. Due i <br />yPrint or Type Only <br />Fa H 3C <br />K n George Haage 608 - 92nd St BE Everett 98208 353-8291 <br />O S O Owner Mailing Aud-ns City Zip Phone <br />It to <br />y <br />[A H <br />568-3054 <br />OX Mailing Address Clly 21p Phone <br />O � Applicant <br />O Bedroom I: bathroom addition to SPR <br />c1. t7 Describe Proposed Work <br />H <br />XH <br />y _ <br />En W <br />H 0 t7 rn Ana a7 a at aP �e <br />Project Address III known) <br />Attach lour 141 copies of plans for proposed work •Draw to scale and note the following of applicable. <br />ICA asa <br />y O CA • Property Lines • C Indicate <br />N nt sliest <br />• Outline and dimensions of all existing and • Indicate North <br />proposed slrurwres on the lot •Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements M <br />DO NOT WRITE BELOW THIS LINE O <br />All� CONDITIONSPERMIT inspection <br />1. All calla IONrinspection shell be made 24 firs In advance phone 21"19•8810. <br />2. All work shall be performed In accordance with this permit and current City OI Everett Design and Construction <br />Standards and Specifications. <br />3, Cali Location Underground Service 48 hisbefore you dig TOLL FREE NUTABER 1.800-424.5555. Z <br />O <br />IIAAAA- <br />- 0 Rq- (2A C s fxsEwi ­rn Q PC, co <br />ACKNOWLEDGEMENT Of OUNDIIIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm - <br />lase 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-ol-way use hereto <br />applied for and further agrees to remove some upon notice from the <br />Approved lot Construction Dale City and to replace public property damaged thereby. <br />FINAL INSPECTION Date Date <br />Approved as Constructed Signature of Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />' PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 1`0 <br />3200 Ceder 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: 259-0810 PROJECT OVER 90 DAYS DURATION <br />