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� <br />TYPE OR PRINT ONLY <br />Owner <br />Applicant <br />Describe Praposed Work <br />Appliwtion For <br />PUBUC WORKS PERMI7 <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-BB70 <br />PROJECT ADDRESS (if known) <br />Public Works Permit d <br />Building Permit <br />Public Works Fee <br />Plan Check No: C 50924 SEPA <br />Applicat.Date: 02/21/96 <br />Job Addreae: 12i5 MADRONA AVn <br />Owner: GUSTAFSON DENNIS & ICATHY <br />Tenant: <br />Proposed Uee: SINGLE FAMILY RESIDENCE <br />Desc. of Work: <br />GARAGE/DECK ADDITION� FULL BATH IN BASEMENT <br />VARIANCE 1-96 <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_�_ gy <br />Phone <br />Phone <br />Attach four (4) copies of plans lor 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 lol •F�cisting and proposed utililies <br />'Centerline of sireet •Indicate North •Show any proposed greding changes •Show measurements <br />.. ...._-----.. ��.�.,���.� <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertormed 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 1-800-4245555. <br />Approved for Constructlon Date <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />�U8L1C �ORKS PEPMi, <br />� � 9E U B <br />�y __ <br />7ATE..�a3 ,�Qi([.�.. <br />W <br />� <br />� <br />� <br />♦i^ <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDIiIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims lor damages, costs, exRenses, or <br />causes of action ihat may arise because of Installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and furtheragrees <br />;o remove same upon notice from the City and to replace public property <br />damaged ihereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUE� AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEfIOiJ. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PflOJECT OVER 90 OAYS DURATION. <br />