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_ ==c � <br /> Date ^ Puolic WOA�Permit• <br /> Appliwtion For BItl9 Deo�.• <br /> PUBLIC WORKS PERMIT °°°°°W°^�F� <br /> Total Fea s <br /> Leu�ool Fee P�iE S <br /> Print or Type Only e.4��eo�� t <br /> Plan Check No: C 42433 SEPA <br /> Applicat.Date: 10/21/93 <br /> Job Addre: 4803 COLBY AVE <br /> Owner: BROWN LAWRENCE <br /> Owner Tenant: p Phone <br /> Propoeed Uee: SINGLE FAMILY RESIDENCE . <br /> Deec. of Work: <br /> HOUSE AND GARAGE ADDN <br /> Applicant p Phone <br /> OFFICE SET JOB SET <br /> Describe Proposed Work _ APPRVD FOR PERMIT: DATE_/_/_ BY <br /> W <br /> Project Address(il known) � <br /> Atlach lour(4)copies of plans lor proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline ol street � <br /> � Outline and dimensions of all ezisting ard • Indicate North <br /> proposed structures on the lol • Show any proposed greding changes <br /> � Existing and proposed utilities � Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shell be made 24 hrs.in adva�ce•phone 259�8670. � <br /> 2.All work shall be peAormed in eccordance with ihie permit and current City of Everetl Design and Co�struction <br /> Standerds and Specificaticns. <br /> 3.Call Location Undergroun�Senice 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> PUBLIC WOqNS PEpM1T O <br /> �NITIA� INi�ECT10k NOT REOUIRED � <br /> KIRK BROOK8 BY <br /> UATE � <br /> � <br /> DATE � Z �q-� O <br /> � � a <br /> �� ��� <br /> ���'` P a��e�^ <br /> � � '� \X/1 � ACKNOWLEDGEMENT OF CONDITIONS <br /> ✓ The undersigned owner/applicant hereb�agrees to hold and save harm• <br /> less the City ol Everett Irom any and all claims for damages, costs, <br /> , expenses, or causes ol action thal may arise beceuse ol installation <br /> antl maintenance of lhe improvement or olher righi-oFway use hereto <br /> appliea for and further agrees fo remove same upon notice (rom the <br /> Approved lor Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signalure ol Applicant Date <br /> � PUBLIC WORKS DEPARTMENT WORK AUTHORIZEO BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CederStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE GITY UPON ANY STOPPAGE OF K'ORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />