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� <br />� <br />'fYPE OR PRINT ONLY <br />�licatlon For <br />PUBLIC WORKS PERMIT <br />Owner I <br />Applitant 1 <br />Descrbe Prop�sed Work <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Evereri, WA98201 259-8870 <br />Date <br />Public Works Permit q <br />Building Permit R _ <br />Public Works Fee $ _ _ <br />Plan Check No: B 50894 SEPA <br />Applicat.Date: 02/16 96 <br />Job Address: 5019 UCKER AVE <br />Oioner: SCHELDT DONNA & PETER <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Work• <br />SOLARIUM ADDITION — UNHEATED <br />OFFICE SET JOH SET <br />APPROVED FOA PERMIT: DATE_/_/_ BY <br />Phone <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following it applicable: <br />�Propeiry Unes �Outline and CimensVons of all existing and proposed structures on the lol •Existing and proposed utilities <br />�Centerline ot street •Indicate Narth `Show any proposed grading changes •Show measurements <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 pertnit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. I�efore you dig. TOLL FREE NUMBER 1-800-424-5555. <br />'UBLIC WORHS PEPM�' <br />40 ( EO IkEn <br />� y `'� / �-�._� <br />sAT E _ '2�'!_ __"' ---- <br />Approved for Consiruction Date <br />FINAL INSPEC?ION Date <br />Approved as Constructed <br />� <br />O <br />/i� <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett }rom any and all claims for damages, costs, ezpenses, or <br />causes of adion Ihat may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public uroperty <br />damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAY3 OF DATE PERMIT IS ISSU[D AND TNEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEIION. THIS PERMIT MAY 8E CANCELLED BY THE CIN UPON ANV STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />