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Date � -- r�uucwon�.ra�u. _ <br /> Application For e�av�oer�.• — <br /> PUBLIC WORKS PERMIT Pu�7aW0FeeF�� : <br /> Less AO�I Fee Pa1E S <br /> Baunc�Uue S <br /> Print or Type Only <br /> Plan Check No: C 47045 SEPA <br /> Applicat.Date: 02/21/95 <br /> Owner Job Addresa: 5029 DELAWARE Phone � <br /> Owner: JONES MARY FRANCIS <br /> Tenant: <br /> Proposed Use: SINGLE FAMZLY RESIDENCE <br /> Deac. of Work: <br /> Applicant REMOVE 6 RESTRUCTURE ROOF, ADD 84SF, Phone <br /> REPLACE WINDOWS, DOOAS, AND RESIDE WITH <br /> Describe Proposed Wark OFFICE SET JOB SET <br /> APPROVED FOR PERMIT: DATE_/_/_ HY <br /> W <br /> Project Address(if known) � <br /> Altach four(4)copies of plans lor proposed work-Draw to scale and note the following as appltcable: � <br /> • Property Lines • Centerline ot street � <br /> • Outline and dimensions of ail existing and • I�dicale North <br /> proposed^lruclures on Ihe lol • Show any proposed grading changes <br /> • Exlstfng and proposed utilities • Show measurements � <br /> DO NO7 WRITE BELOW THiS LINE O <br /> PERMIT CONDITIONS <br /> i.All calls for�ns�ection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work sha:l bo pedormed in accordance with thfs permit and current City of Everett Design and Constr�cUon <br /> Standards and Specilications <br /> 3.Call Location Underpround Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> rUDLIC WpqKS PEPMI7 � <br /> tvpl' REOUIRE� ,�/� <br /> DY � V� <br /> DATE 2s ��_ �_� O <br /> t <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Everetl Irom any and all claims for damages. costs, <br /> . expenses, or causes of action ihal may arise because ot installa�.lon <br /> and maintenance of Ihe improvement or other right•ol•way use hereto <br /> applied for and furiher agrees lo 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 Signature ol Applicanl Date <br /> ���I� PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br /> Everett,WA98201 BE DILIGENTLY PUfiSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259�8870 CANCELLED BY THE CITY UPON ANY STOPPAtiE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />