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Date � ^ <br /> PuOi¢WorMs Permit• <br /> APP�ication For —�—" <br /> Bltlg Deo�.• <br /> PUBLIC WORKS PERMIT P��bbcWO��aFeB <br /> To�a��e< s <br /> --.__ <br /> less 4op� Fnp pa�a 5-- <br /> Print or Type Only ea�,��ec�� 5 <br /> Plan Check No: B 4/4692 SEPA I <br /> APPJobaAddree�3/071COLBY AVE <br /> Owner Owner: HOUSING AUTHORITY <br /> � Tenant: Z�n <br /> Propoeed Uee: OFFICE Phonr. <br /> Deec. of Work: <br /> . TI TO PROVIDE ACCESSIBILITY 6 4 MEETING <br /> � . APP�icam ROOHS <br /> OFFICE SET ''� Phon� —' <br /> JOB SET <br /> ; Describe?�oposed Work APPRVD FOR PERHIT: DATE <br /> _..�_/__ 8Y <br /> Prolect Atldress(d known; W <br /> Attach four�4)copies ol pians lo� nronw�d H�u•s � H <br /> Drav: 1:�yr.aiN.ina nCle Iha 'c�luwing as apGlir.abie. <br /> • Property Lines • Centerlinn n�street _ <br /> • Outline and dimensions ol all eaishng and � �„ i � <br /> proposetl structurec an the lot C cal? North <br /> • Eristino and proposed utilities • �hew any r,�enosetl gratling chan�eq <br /> • Shnw measurements <br /> DO NOT WRITE 6ELOW Tf71S LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls lor inspection shall be matle 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be peAormed in accordance with this permil and current City ol Everett Design and Construction � <br /> Standards and Specifications. <br /> 3.Call Location Underground uervice 48 hrs.before you dig.TOLL FREE NUMBER 1•$00•424•5555. <br /> � <br /> O <br /> 'UBLIC WORKS PERMIT <br /> NOT REQUIREt1 � <br /> �Y //� <br /> �)ATE C• / _ VJ <br /> / O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ___ ` The u�der���ned owner/appiicant hrr2�y agrees to hold and sace harm- <br /> j less :he City c� Eve�ett f�om ar.y and ali Uaims for dame,ges. cos�� <br /> � ekpenses. o� tauses of aclion that may anss 6ecause of msiailai�en <br /> � -�- dnA m,iinlenance q! Ihe irnprOvement or o�he� ngh}�pbway use hereto <br /> Approved IorConstructi0n Date ; �'�'�^`: for and I�rther agrces to remove same upon notice hom the <br /> � Cdv anA to replace public properiy damaged thereby. <br /> i <br /> FINAL INSPECTION Date <br /> ApUroved as Constructed <br /> Slgnature ol Applicant Date <br /> ��r� PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COhIPLETION. THIS PERMIT MAV BE , <br /> Phone:259•8810 CANCELLtD BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJEGT OVER 90 DAYS DURATION. <br />