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Date <br />ApplicanL. . or <br />PUBLIC WORKS PERMIT <br />Print or rype Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />Project Address (if known) <br />Plan Check No: C 4065 SEPA <br />Applicat.Date: 05/11�93 <br />Job Address: 5017 3RD AVE W <br />Owner: WINKEL ROBERT <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Work: <br />ADDITIONS TO EXISTING HOUSE <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Public Works Permit e <br />gift Dept e <br />Public Works Fee <br />Total Fee S <br />Leea APPL Fee Ped t< <br />BAlance Due s <br />Zip Phone <br />Zip Phone <br />Attach four (4) copies of plans for proposed work - Drew to scale and note the following as applicable: <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259.8810. <br />2. All work shall be portormed In accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3, Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424.5555. <br />PUBLIC WORKS PERMIT <br />N7)�f UIREO <br />DATE <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />41L 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />z <br />O <br />U) <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims fcr damages, costs, <br />expenses, or causes of action that may arise because of Installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTFA IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEP.MIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />