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Data <br />Applfcatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Dascribe Propaud Work . <br />Pro�ect Address (if known) <br />Plan Check No: 8 46817 SEPA <br />Applicat.Date: O1/24'95 <br />3ob Addreas: 5027 bOVER ST <br />Owner: SUTTON CHRIS <br />Tenant: <br />Proposed Uee: SINGLE FAMILY RESIDENCE <br />Desc. of Work: <br />ADDN FOR SEWING ROOM & HEDROOM <br />P�Clit Work� Pvmit • <br />BI00� DtD� � � <br />vueiK won�. v.. <br />iatnFo S <br />Leu �ppt F�� G�IE S <br />eaunq pue S <br />ZiP Phone <br />OFFICE SET JOB SET Z�p phone <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Attach four (4) copfes ot plens for proposed work - Draw to scale and note the followfng as applicable: <br />• Property Lines <br />• Outline and dimensfona ol all existing and <br />proposed structures on the lot <br />• Existinq and proposed utllities <br />• Centedtne of street <br />• Indicate North <br />• Show eny propased gradtng changes <br />• Show measurements <br />PERMI7 CONDITIONS <br />1. All cells for inapedbn ahall be made 24 hrs. in advance • phone 258-881 O. <br />2. All work ahell bs performed in accordence with this permit and current City of Everett Design and Construction <br />Standarda end Specificationa <br />3. Call Locetlon Underqround Service 48 hrs, before you dig. TO�L FREE NUMBER 1•800-424•5555. <br />FUBLIC W�ORKS PEPMIT <br />y �EOUIRE� <br />�Y� <br />OATE Z �J 5' <br />----�_ <br />Approved for Construction <br />FINAL INSPECTION <br />Approved as Constructed <br />��PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everet; WA 98201 <br />Phone: 259•BB70 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett Irom any and atl claims for damage& costs, <br />expensea or causes of action that may artse beceuse of installation <br />and maintenance of the improvement or other right•of•way use hereto <br />applied for and lurther agrees to remove same upo� notice from the <br />Ciry and to replace public propeAy damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLEO Bl' THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJFCT OVER 90 DAYS DURATION. <br />