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� Applicatlon For <br />� PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everelt, WA 98201 (425) 7_57-8810 <br />TYPE OR PRINT ONLY <br />Owner <br />ApPliwnt <br />Describe Proposed Work <br />Plan Check No.: B9907-048 <br />Job Address: 510 MADISON ST <br />Owner: OSBORN GEORGE <br />Tenant: <br />Appliwtion Date: 7/23/99 <br />Proposed Use: SFR <br />Type of work: HOUSE ADDITIONS <br />Office Ss�— lob Set Fire/Planning Sek <br />Approved For Permit: Date: By: <br />PROJECT ADDRESS (if known) <br />D� <br />Public Works Permit P <br />Building Permit # _ <br />Pubiic Works Fee $ _ <br />Phone <br />Phone <br />Attach four (4) copies plans for proposed work - Draw to scale and note the following if applicabie: <br />• Property Lines • Outline and dimensions of all existlng and proposed structures on the lot • Ex(sting and proposed utilitles <br />• Centerline of street • Indirate North • Show any proposetl gradln9 changes • Show measurements <br />DO NOT WRITE SELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. AII calls for inspection shail be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shali be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specitir,ations. , <br />3. Call Location Underground Serv;ce 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />?UQLIC WORK4 *ERMI � <br />�OT�FjEOUIRE� <br />tY.---� {/(�- <br />�eTF.---•��11 _._ <br />pprove or ons ruc on ate <br />FINAL INSPECTION <br />Approved as Constructed <br />Date <br />W <br />� <br />� <br />V / <br />� <br />� <br />r <br />V / <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedaoplicant hereby agrees to hold and save harmless <br />the Ciry of Everett trom any and all claims for damages, costs, ezpenses, or <br />ca�ses of acUon that may arise because of insWtlatlon and maintenance ef Ihe <br />improvement or other right-of-way use hereto applied for and fuMer agrees to <br />remove same upon notice irom the City and to replace pu6iic property dam- <br />aged thereby. <br />igna ure o pp ican a e <br />WORK AUhiOR�D BYlH15 PERMR MUST BE STAIiIE� WITFIIN 180 DAYS OF DA7E PERMfT IS ISSUED AND iHEREAFfER IS TO BE D11JG�ENiLY PURSUm �N <br />COMPLET10N.7HIS PERMIT MAY BE G1NCEl.1F0 BY lHE C(TY UPON ANY STUPPAGE OF WORK rN111'�i5 PRQIECT OVER 90 DAYS WRATION. <br />