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Date <br />C <br />qpplica[ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: C 48846 SSpA <br />Owner ApPlicet.Date: O6/30/95 <br />Job Addr�: 526 COLBY AVE <br />Ownei7 LUCAS WILLI}1M/LISA <br />Tensnts <br />Applicant <br />L?escribe Proposed Work <br />Proled Address (if know�) <br />Propo�ed U�a: SINGLE FA!lILY RESIDENCE <br />De�c. of Norks <br />11DDING 2ND FIAOA AND REC ROOM IN Bl1CR OF <br />HODSB <br />v�eiwwen.o•,mn. _ <br />eaQo.o�. — <br />hW�e Wwk� FN <br />TWNFe� s— <br />Lo� �ool Fea P�iC f— <br />Ba4ric� Du� S _ <br />Phone <br />Phone <br />OFFICE S6T JOB SET <br />APPAVD FOR PERMIT: DATE_/_/_ BY � <br />Atlach four (4) copies of plans for proposed work • Draw to scale and note �he following as applicable: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />propo5ed slructures on the tot <br />• Existing and proposed utilities <br />• Cen;erline ol streel <br />• Indicale North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 O. <br />2. All work shall be performed in accordance with this permit and current City ol Everett Design and Construction <br />Standards and Specificatfons. <br />3. Calt Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•600�424•5555. <br />�'UBLIC WORK3 PERM�' <br />h0 f R qU1RE� <br />eY_ ' <br />,+ATF _.���_� <br />Approved lor Consirudion Date <br />FINAL INSPECTION <br />Approved as Constructed <br />�ArI�PUBLICWORKSDEPARTMENT <br />3200 Cedar Street <br />Everett,l'�.A 98201 <br />Phone: 259•8810 <br />Date <br />ACKNOWLE�GEMENT OF CONDITIONS <br />W <br />H <br />� <br />�� <br />The undersigned owner/applicant hereby agrees lo hold and save harm• <br />less the City of Everelt Irom any and all ctaims lor damages, costs, <br />e+cpenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of•way use hereto <br />applied for and lurther agrees to remove same upon nolice from the <br />Cily and to replace public property damaged thereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT M4Y BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />