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C�� <br />TYPE OR PRINT ONLY <br />Gwner <br />Applicant <br />Applketlon For <br />PUBLIC 1 JRKS PERMIT °et. <br />Describe Proposed Work _ <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPNHTMENT Public Works Permit N <br />3200 Cecfar Street — <br />Evarett, WA 98201 259-8810 <br />Building Permit N <br />Plan Check No: C 50846 SEPA csFeeS <br />Applicat.Date: 02/12/96 <br />Job Addresa: 5178 S 3RD AVE <br />Owner: SCHIELMANN FW <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE ?hone <br />Desc. of Work: <br />ADDITION, NEW FOUNDATION <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Phone —_ <br />Attach lour (4) copies ol plans for proposed work - Draw to scale and note ihe following if applicable: <br />•Property Lines "Outline and dimenslons of all exisling and proposed structures on the �ot •Existing end propos?d utilities <br />•Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shatl be made 24 hours in advance - phone 259-8810. <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 />UBI.IC '�vOqKS PEPM�, <br />'�Oi ?F.CWREn <br />: y --�'�' _ _ _ <br />,�*=_ _t�' YG__.. <br />Approved for Constniction Gata <br />FINAL INSPECTION Date <br />Appmved as Canslructed <br />W <br />N- <br />- <br />v, <br />; <br />♦�A <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplicant hereby agrees to hold and save harmless <br />the Ciry of Everett from any and all claims for damages, cosis, expenses, or <br />causes o� actlon that may arise because of installation and maintenance of <br />ihe improvement or other right-o}-way use hereto applied for and lurther agfees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 100 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WOFiK ON THIS PROJECT OVER 90 DAYS DURATION. <br />