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�'ate Pu01ic Work�Permil• <br /> Application For eiep.oeo�.• <br /> PUBLIC WORKS PERMIT PueTotalFeeFea s <br /> less aoo�Fee Pela S <br /> 9aiance Due S <br /> Print or Type Onty <br /> Owner Plan Check No: C 48494 SEPA — <br /> AppLicat.Date: 06/02/95 Phone <br /> Job Addrese: 16b6 hUCKER AVE <br /> Owner: SCHULTZ JOHN <br /> Tenant: <br /> Applicant Propoaed Uae: L;NGLE FAMILY RESIDENCE Phone <br /> Deec. of Work: <br /> 2ND STORY BEDROOM AND MAIN FLOOR FAMILY <br /> ROOM ADDITION <br /> Describe Proposed Work _ <br /> OFFICE SET JOB SET <br /> APPFOVED FOR PERMIT: DATE_/_/_ BY <br /> _ _ W <br /> Prolect Address(if known) _ � <br /> Attach four(4)copies of plan;for oroposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and din.^:�sions oi all existing and • Indicale Norih <br /> proposed structures on the lot • Show any proposed gradirig changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.AII calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be peAormed in accordanca with this permit and current City of Everett Design and Conslruction tt <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> O <br /> /�/� <br /> PU�LIb WORKB I�FRMI�� V♦ <br /> t: �RbGUIt1�A O <br /> !Y y y -- � <br /> �/Ilf�._-- _ __–� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersiqned owner/applicant hereby agrees lo hold and save harm� <br /> less the City of Everell from any and all claims for damages, cosis, <br /> ezpenses, or causes of action that may arise hecause of installation <br /> and maintenance of the improvement or other right-ol-way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved lor Construdion Date Cily and to replace public prope�ty damaged thereby. <br /> FINAL INSPECTION Date � <br /> Approved as ConsVucted Signature of Applicant Dete <br /> �A�I� PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAG[OF WORK ON THIS <br /> Phone:259�A810 PROJECT OVER 90 DAYS DURATION. <br />