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Date <br />( <br />Application For <br />PUBLIC WORkS PERMIT <br />Print c+r Type Only plan check No: B 50284 <br />Applicat.Date: 12/12�95 SEPA <br />Job Addreae: 724 5 RD ST SW <br />Owner: PIDGEON KEN <br />Tenant: <br />Owner Propoaed Uae: SINGLE FAMILY RESIDENCE <br />Deac. of Work: <br />FAMILY ROOM ADDITION <br />Applicant <br />Describe Proposed Work <br />Project Address (if known; <br />�PUELc Worw� Pe�mil r <br />� <br />eiea. oeoi. + _ <br />PuEb[ Wo�wf Fee <br />Totrl �ee S <br />Less 4001. Fee PaiO $ <br />BaianceDuG S <br />ZiP P <br />OFFICE SET JOB SET Z�a Phone <br />APPROVED FOR PERMIT: DATE /_�_ gy <br />Attach four (4) copies ol plans for proposed wurK • Drew, to >r.al.� ann ncte the fo�lowing as appGcabie: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed slructures on the �ot <br />• Existing and proposed utilities <br />• Ge�iterline ol slreet <br />• Indicale Norih <br />• Show any croposeA grading changes <br />• Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be matle 24 hrs. in advance - phone 259•881 O. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construclion <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•SW-424-5555. <br />?UBLIC 'vJORKS PENMIi <br />WGT REUUIREn <br />� <br />�Y_! u <br />iATE /Z /3 _1 S _ <br />Approved for Construction Date <br />FINAL INSPECTION � Date <br />Appioved as Constructed <br />�A��PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98207 <br />Phone: 259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersiqned owner/applicarit hereby agrees to hold and save harm- <br />less the City of Everetl Irom any and all claims lor damages. costs. <br />e.penses. or causes of aclion that may arise because of installation <br />anA maintenance o! ihe improvement or other right-of-way use hereto <br />aGP��ed �or and further agrees to remove same upon notice from the <br />C�;y and to replaca public property damaged thereby. <br />Signa�ure of Applican! Date <br />WORK F�UTHORIZED BY THIS PERMIT MUST BE STAqTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DII.IGERTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLEO BY THE GITY UPON ANY STOPPAGE OF N�ORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />