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'ication For <br />PUBLIC JRKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />TYPE OR PRINT ONLY <br />Date ( ' <br />Public Works Permit M <br />Building Permit # _ <br />Public Works Fee $ _ <br />Plan Check No: C 56812 SEPA <br />Applicat.Date: 10/16�97 <br />Owner Job Address: 35228 EDERAL AVE Phone <br />Owner: STROUD JEFF <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Applicant Desc. of Work: Phone <br />ADDITION OF SECOND FLOOR AND 1ST FLOOR MUD <br />ROOM <br />Describe Proposed Work _ OFFICE SET JOB SET I U <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />PROJECT ADDRESS (if known) 4S• <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines `Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities O <br />•Centerline of street •Indicate North 'Show any proposed grading changes •Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. O <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />r <br />`,I:LIC WORKS PER4tlr <br />E <br />N it EUUTAr.* <br />• ATE. __._..40 <br />NBC- w �S UjdeV 44A� ?i f(on <br />tlac�r�� pig <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />