3924 COLBY AVE 2016-01-01 MF Import

Applitalion Fo� � ,( � PUBLIC WORKS PERMIT Date 11-3-95 ��„ PUBLIC WORKS DEPARTMENT Public Works Permit q 9S Sj-'' 3200 Cedar Street Everett,WA 98201 259-BB10 Zi , APR 11 19��'ilding Permit p IYPE OR PRINT ONLY ��' PO STI N G Public Works Fee$ �� ' Everett Clinic 3901 Hoyt Ave Everett 98201 339-5460 Owner Mailing Address Cit Y ZiP Phone Applicant Mailing Address City Zip Phone 1?J07/45 10:21RM QDC�AN34B 1�:�e Describe Proposed Work paricing lot / D�iiVW�1 �3g.0� � lI�OOD6746 /�� ' � V♦ PROJECTADDRESS(if known) 3924 Colby Ave :kkT1L 4862.00 Attach fom(4)copies o(plans lor pmposed work-Draw to scale and note the fullowin if a licable: , � � 9 PP CHkG AS.QO O �. •Property Lines 17utline and dimenslons of all existing and proposed structures on the lot •Existing antl proposed utilities � •Cenledine of street •Indicate North •Show any proposed 3rading changes •Show measuremenis DO�OT WRITE BELOW THIS LINE � PERMIT CONDITIONS: � 1.All calls for inspection shall be made 24 hours in advance- phone 259-8810. 2. All work shall be pertormed in accordance with this permit and current City of Everett Design and o Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � 9 C�,��,� ?z� �� /�a,i/ce P�'.E �I/',�/'.-v�-,�/� V� U/C��lt.%�IJCi$ D/JTrV �/'.>'��-7.c ��D�l/ f��ACf/L�� ) O � J a ' ACKNOWLEDGEMENT OF CONDITIONS i � The unde ;igned owner/applicant hereby ogrees to hold and save harmless �. _��;_�s Iho City of Everett from any and all claims for damages,costs,expenses,or 1 Approved to onshuction Date — causes of action that may arise because of installation and maiitenance ot ihe improvement or o0�er right-obway use hereto applied tor and further agmes ' ��i 2o remove same upon notice from the City and to replace public property � _ ._�� 'S� damaged thereby. � FINA IN PECTION Dat Ap�ed as Construyt d�� -� . � l,.y� :.` —i0 - �� .� /L-7_95 � Signature of Apphcant Date � WORK AUTHJRIZED BY hi15 PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO � COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON AN I STOPPAGE OF WORti ON THIS PROJECT OVER 90 DAYS DURATION. � � — _. ;r_.