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� iYPE OR PRINi' ONLY <br />Uwner <br />Applicant <br />A� Aion Fw <br />PUBLIC WURKS PERNIIT <br />� Describe Proposed Work _ <br />PUBUC WORKS DEPARTMENT <br />32D0 CeCar Street <br />Evereri, WA 98201 259-8810 <br />Date <br />PuDI'�c Works Pertnit � <br />Building Pertnil R _ <br />Puhlir. Works Fee S _ <br />Plan Check No: C 58050 SEPl� <br />!�pp lic,et.Dnte: 03/O7 98 <br />Job Addreee: 6801 ROADWAY <br />Owner: FORBES DONALD/OANH <br />7'enant: <br />Propoeed Uee: SINGLE FAlSILY RESIDENCE <br />Desc. of Work: <br />ADDITION ON SECOND FLOOR <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ 8Y <br />� PROJECT ADDRESS (if known) <br />� Anach four (4) copies of plans lor proposed work - Draw lo scale and note the following il appliwble: <br />Phone <br />Pnone <br />•Property Lines •Outline and dimensions ol all existing and proposed structures on the lot •Existing anC oroposed utilities <br />•Centerline ol street •Indicate Nonh •Show any proposed grading changes 'Show measurements <br />LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shail be performed in accordance with this perm.it 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-SS55. <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />"UfiLIC WORKi �ERMI � <br />kG1 ��UU1Rr� <br />E Y_�� i SYIn <br />�ATC.-- '�i��%y� , <br />`��r(/. _ ` <br />W <br />� <br />� <br />v / <br />� <br />O <br />� <br />� <br />O <br />��/� <br />V ♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDfT10NS <br />The undersigned ownedappticanl hereby agrees to hold and save harmless <br />the City of Everen from any and ali claims for damages, costs, expenses, or <br />causes ol action that may arise because ot Installation and maintenance of <br />the improvement or other righbol-way use hereto applied for and further agrees <br />to removn same upon notice fmm the City and to replace public property <br />damaged thereby. <br />Signature of Applicant Date <br />'i VJORK AUTHORIZED BY 7NIS P[RNIT MUST BE STARTED WITHIN 780 DAYS OF DATE PERMIT IS ISSUED AND THERFAFfER IS TO BE DILIGENTLY PURSUED TO <br />�, COMP�EfION. THIS PERti11T MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS W RAT10N. <br />