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�^_ � Publle Worb Parm�t• <br /> Date <br /> � BIEq.Dao�• <br /> Application For <br /> PUBLIC WORKS PERMIT P°°:o,:°F:F•° s <br /> �eas noo�Fae aa�e S <br /> Bd�nce Due S <br /> Print or Type Only <br /> Plan Check No: B 47924 <br /> SEPA <br /> ppplicat.Date: 04/03/95 <br /> Owner Job AddYeee: 5117 Z3RD AVE �'1 Phone <br /> Owner: BENTHUYSEN JIM <br /> Tenant: <br /> Proposed Use: SINGLE FAMILY RESIDENCE <br /> Applicant Desc. of WOrSEWING Ti00M Phone <br /> ADDITION <br /> JOB SET <br /> Describe Proposed Work OFFICE SET�_ <br /> pppgOVED FOR PERMIT: DA7'E�/_I_ BY <br /> W <br /> Project Address(if known) � <br /> Attach four(4) copies of plans for proposed work• Drew to scale and note the�uliowing as applicable: � <br /> • Property Lines • Centedine of street � <br /> • Outline [ind dimensions of a�l existing and • Indicate North <br /> proposed structures on the lot • Show any proposed gradin9 changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> � 1.All calls for inspectbn shall be made 24 hrs.in advance•phone 259-8810. � <br /> . 2.All work shall be performed in accordance with thfs permit and current City of Everett Design and Constructfon <br /> � ' Standards and Specificatfona <br /> j, ' 3.Call Lccation Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> } O <br /> � <br /> r U8��,fWRE0U1RE4 �IT � <br /> �Y O <br /> r��Te a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Eve{ett irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise 6ecause of installation <br /> � and maintenance ol lhe improvement or other right•of•way use hereto <br /> applied for and f�irther agrees to remove same upon notice from the <br /> Approved for Construction Date L'ity and to replace public property damaged thereby. <br /> FINAL INSPECTION Da[e Date <br /> Approved as Constructed Signature of Applicanl <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �A`� PUBLICWORKSOEPARTMENT I80 DAYS OF DATE PERMIT IS ISSUED PND THEREAFTER IS �TO <br /> 3200 Cedar Street gE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DIIqATION. <br />