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Date P�e�,�v,o,k:re�m,�. <br /> qppiicalion For maQ oen� ._ <br /> PUBLIC WORKS PERMIT °°°:o,:F�;F°° 5 <br /> lesf Aoo�Fea Pa�C S <br /> Baia�ce0ue 5 <br /> Print or Type Only <br /> Plan Check No: C 27471 SEPA <br /> y C] H Applicat.Date: OB/02/91 <br /> � � '� Job Addreae: 4920 SL'AHUAST AVE <br /> A � y Owner: SINDELAR, DALE A <br /> j x ���ef Tenant: Phonc <br /> C H Proposed Use: SINGLE FAMILY AESZDENCE � <br /> y y y Desc. of Work: <br /> � �� REMODEL W/ADDN 2688 SF <br /> H <br /> Applicant Phone <br /> K y� OFFICE SET JOB SET <br /> "��y H APPROVED FOR PERMIT: DATE <br /> Describe Proposed Work _�_�_ BY <br /> �O� — <br /> OH <br /> ��g W <br /> �y� Proiect AdOress(il known) � <br /> Attach lour�4)copies ol ptans for proposed work� Draw to scale and note Ihe lollowing as applicable: � <br /> �~ y • Property Lines • Centerline o:slreel /^ <br /> y <br /> N • Outline and dimensions ol all exisling and • Intliwte No�ih V� <br /> O C�� proposed structures on ihe lot • Show any proposed grading changes <br /> � � • Existing antl praPosed utilities � Show mea5uremeMS <br /> �j � y DO NGT WRITE BELOW THIS LINE � <br /> � PERMIT CONDITIONS O <br /> t.All calls lor inspection shall be matle 24 hrs.m advanca•phone 259•8810. � <br /> � 2.All work shall be pedormed in accordance with this permit and currenl City of Everett Design and Construction <br /> SlanCards and Specifications. <br /> 1 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � �� ' <br /> ; �,',;. ` I(/,;/�-, /-�r��. � ��' � /1��.. ,, t � � <br /> �� � <br /> ' l�`-( f�j `�—�_,- � <br /> � ' �!� I .' � ' � -- <br /> - a <br /> �- <br /> __ <br /> ACKNOWLEDGEh1ENT OF CONDITIONS <br /> The undcrsigned owneVapplicaN hereby agrees to hold and save harm� <br /> � � less ihe City of Everelt Irom any antl all claims lor damages, cosis. <br /> _ enpenses. or causes ol action iha� may arise because of installalion <br /> and maimenance ol Ihe impwvement or o�her righ4ohway use hereto <br /> , applied �oi and luriher agree5 �o �emove SamC upon notiCe from the <br /> Approved for Construc�ion Dale GIy and to replace public F�operty damaged lhereby. <br /> FINAL IN:PECTION Date <br /> ApproveA as Consiructed Signatwe ol Applicani �ate <br /> ��M� PU�LICWOFKSDEPARTMENT WORK AUTHORIZLD BY THIS PERMIT MUST BE STARTE� WITHIN <br /> 3200CedarStreet 1B0 D�YS OF DATE PERMIT IS ISSUED AND TIIEREAFTER IS TO <br /> Everett,WA gp207 OE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phane'259�8810 CANC[LLED B\'THE CITY UPON ANV STOPPAGE Or WORK ON THIS <br /> � Pf70JECT OVEf 90 DAYS DURATIC�N. <br />