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TYPE OR PRINT ONLY <br />ADpliw�ion For <br />PUBLIC l JRKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everott, WA 98201 259-8810 <br />Jwner Maili <br />Applicant Mai'�. <br />Describe Proposed Work <br />FROJECT ADDRESS (if known) <br />Plan Check No: <br />AppLicat.Date: <br />Job Addresa: <br />Owner: <br />Tenant: <br />Proposed Use: <br />Desc. of Work: <br />BATH / LAUNDRY <br />Dat <br />PcSlic Works Permit M _ <br />Building Permit 8 __._ <br />Public VJorks Fee S <br />C 51340 SEPA <br />04/05/96 <br />3838 RUCKER AVE <br />BUSH JOHN <br />SINGLE FAMILY RESIDENCE <br />ADDITION <br />OFFICE SET .708 SET <br />APPROVED FOR PERMIT: DATE_/_/_ By <br />Phone <br />Atl�ch four (4) copies of plans for proposed work - Oraw to scale and note the following if applicable: <br />•Property IJnes �Outline and dimensions of all existing and proposed structures on the lot •Existiny and p�ropo,ed utilities <br />•Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All call� for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. l.II work shall be pertormed in accordance with this pertnit and current Citv of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 7-800-424-5555. <br />-'�!RLIC N�ORKS PERM" <br />�+0� QEOWREP <br />,y_�:� <br />a.�Te_ �i .��;�, <br />� ____.. <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />W <br />� <br />� <br />� <br />'�^ <br />�I / <br />O <br />a <br />ACKNOWLEDGEMENT OF CONUITIONS <br />The undersigned owner/applicant hereby agrees to hoid and save harmless <br />the City c1 Everetl Irom any and all claims for damages, costs, ezpenses, or <br />causes o1 action that may arise because ol installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and IuAher a;�rees <br />to remove same upen notice irom ihe City and to replace public Froperty <br />damaged thereby. <br />SignaWre of Appliwnt Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE i'ERMIT IS ISSUED AND 1HEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPIETION. THIS PERMIT MAY BE CANCCLLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />