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-ation For '� <br /> � PUBLIC VI�vRKS PERMIT Date �. <br /> �3,�„ <br /> PUBLIC WORKS DEPARTMENT Public Works Permit N � <br /> 3200 Cedar Street 'x <br /> Everett,WA 98201 259-8810 Building Permit M �� <br /> TYPE OR PRINT ONLY Public Works Fee S � <br /> ;r <br /> s� <br /> Plan Check No: B 56666 SEPA ? <br /> Owner Applicat.Date: 10�03/97 Phone i <br /> Job Addreee: 49 5 $LM ST <br /> Owner: SHAVER RICHARp D '� <br /> Applicant Tenant: Phone <br /> Propoeed Uee: SINGLE FAMILY RESIDENCG <br /> Desc. of Work: <br /> DINING ROOM ADDITION � <br /> Describe Proposed Work _ <br /> OFFICE SET JOB SET � <br /> APPROVED FOR PERMIT: DATE_/_/_ BY � f� <br /> �I/ <br /> PROJECT ADDRESS(if known) _ � <br /> Attach four(4)copies of plans for pmposetl work-Oraw to scale and note the foilowing if applicable: O <br /> •Property Lines 'Outline and dimensions of all oxisting and proposed shuctures on the lot •Ezisting and pmposed utilities - <br /> •Centerlino of street •indicate North •Show any proposed greding chan9es •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1.All cails °or inspection shail 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 /> V♦ <br /> �(�� � U��icK�c' S �c�c���,-�e=� �� �ti-te'�,-f- U I�G_ ��-er� �-ric�e.,r � t <br /> r <br /> � ie:,� �.����; -4���� . � <br /> "U�LIC WORKS �EMIl3 <br /> wot REau�ss <br /> LY..._�-1�-- <br /> �:�7E�:� c 1 <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 /> Approved for Construction Date causes of action that may arise because of installation and maintenance of <br /> theimprovementorotherright-of-wayuseheretoapplied(orandfunheragrees � <br /> to remove same upon notice from the City and to 2place public properry <br /> damaged thereby. <br /> FINAL INSPECTION Date . <br /> Approved as Constructed <br /> Signature ol Applicant Date � <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TG BE DI�IGENTLY PURSUED TO � <br /> COMPLEfIQN.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. � <br />