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Date <br /> � PupGc WorFs Pe�mi1• <br /> Application For -- <br /> BIOp.DeOt• <br /> PUBLIC WORKS PERMIT P�°To��eeFee s <br /> - <br /> Leu�oDl Fee PaiC S_-_ <br /> Print orType Only ea„�«o�� s_�_ <br /> Plan Check No: C 49047 SEPA <br /> Applicat.Date: 07/25/95 <br /> Job Addre: 1632 COLBY AVE <br /> Owner — Owner: WASILOWSRI RICHARD <br /> Tenant: Phone <br /> Proposed Uae: SINGLE FAHILY RESIDENCE <br /> Deec. of Work: <br /> ADDITION <br /> AppliCant � <br /> Phone <br /> OFFICE SET JOB SET <br /> Describe Proposed Woik APPRVD FOR PEAMIT: DATE_/_�_ By <br /> -- <br /> Project Address(if known) � <br /> Attach lour(4)copies of plans lor proposed work- Draw to scale and note Ihe following as applicabie: � <br /> • Property Lines • Centerline ol strect I— <br /> • Outline and dimensions ol ali existing and • Indicate Norih � <br /> proposed structures on the lol • Show any proDosed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br />� PERMIT CONDITIONS O <br /> 1.A�i calls for inspection shall be made 24 hrs.in advance•phone 259•8810. <br /> 2.All work shall be pedormed in accordance with this permit and current City of Evereft besign and Conslruction � <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs,before you dig.TOLL FREE NUMBER 1•800•424-5555. <br /> � <br /> O <br /> �u���C WORK3 PEPMI� � <br /> �'�jqEQU1REn w <br /> F Y,_� � <br /> '4TE. ._,.// �� 9 S' _ O <br /> / <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and sace harm- <br /> . less Ihe City of Everett Irom any and all clalms for damages, costs. <br />. expenses, or causes o� aclion Ihat may arise because ot installation <br /> and mainlenance of Ihe improvemenl or other righ(-obway use hereto <br /> Approved for ConsVuction Dale applied for and lurther agrees to remove same upon notice Irom Ihe <br /> City and to replace public properly damagetl thereby. <br /> FINAI INSPECTION Dale <br /> Approved as Conslructed S�gnalure ot Applicant - <br /> Date <br /> PUBLIC WORKSDEPARTMENT WORK AUTHOfl12ED BY THIS PERMIT MUST �E STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEfiEAFTER IS TO <br /> Everell,WAg8201 DE DILIGENTLY PURSUED TO COMPLET!ON. THiS PERIdIT M�Y [3[ <br /> Phone:258-BB10 CANCELLC-D 8Y THE CITY UPON ANY STOPPAGC OF W'OHK ON if115 <br /> PROJECT OVER 90 DAYS UURATION. <br />