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� <br />TYPE OR PRINT ONiY <br />Owner <br />Applicant <br />. ,opliu�ion Fa � <br />PUBLIC �_ORKS PERMIT Da <br />Describe Proposed Work _ <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT Public Nbrks Permit M <br />3200 Cedar Street <br />Evereri, WA 98201 259-8810 Building Pertnit 1_ <br />Public Works Fee S _ <br />Plnn Check Ho: C 53329 SEPA <br />Applicat.Date: 30/25/96 — <br />Job Addtees: 5320 W6TMORE AVE <br />Jwner: HENDRICKSEN BURT <br />Tenant: <br />Proposed Uee: SINGLS FAMILY RESIDENCE — <br />Deec. of Work: <br />NEW FOUNDA'_'ION AND ADDITION <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: Dl1TE_/_/_ 8Y <br />Phone <br />Phone <br />Atlach four (4) coples of plans for proposed work - Draw to scale and note ihe following if applica�le: <br />•PropeRy Lines 'Outline and dimensions of �II existing and proposed siructures on the lot •Ezisting and proposed utilities <br />•Centerline of sireet •Indicate North �Show any proposed grading changes 5how measurements <br />PERMIT CONDITIONS: <br />1. All �alls for inspection shall be made 24 hours in advance - ptione 259-8810. <br />2. All v+ork shall be performed in accordance wi:h this pertnit 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 />Approved tor Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmiess <br />the City of Everett from any and alI claims tor damages, costs, ezpenses, or <br />causes of action that may arise because of instaliatlon and maintanance ot <br />ihe improvement or other right-of-way use hereto applled for and further agrees <br />to remove same upon notice from ihe Ctty and to replace public property <br />damaged ihereby. <br />r' <br />Signature of Applicant Dato <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 �AYS OF DATE PERMIT IS ISSUED AND THEREAFiFH IS TO BE DILIGENTLV PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE C�INCELLED BY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS WRATION. <br />