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� PUBLIC�ORKS pERMIT °��-� <br /> �,a����� ����« <br /> ��� <br /> E�e�n,wn aesoi zse-eeio eu�awro aem,n r <br /> TYPE OR PRINT ONLY PuMfc Mbrks Fee S <br /> Plan Check No: C 56301 SEPA <br /> Ownx 1lpplioat.Data: OB[21 97 Phons <br /> Job 71ddr�: 113o C D AVE <br /> Ownar= UYBMURA Y MICHAEL <br /> Tanants <br /> q���t Propo��d Ures SINCLE FAMILY RESIDENCE p�y <br /> De�c. of Work: <br /> RSMODBL, ADD DORMBRS <br /> ��ri�P�o���� _ W <br /> OFFICS SET JOB SET <br /> APPRVD FOR PBRMIT: DATE_/_/_ BY � <br /> � <br /> � <br /> PROJECT ADDRESS pf known) � <br /> Attach four(4)coplea of plsns tor proposed work-Draw to xab and note the followiny H epplkable: O <br /> 'Property Lines 'Outllne and dimensbru ot sll eziatNp and proposed ahucturea on ths bt �Exlstlnp and propo�ed Wllkba <br /> 'Centerllne o1 street •Indkats Nath 'Show any proposed gredinq changes 'Show msesuremenh � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � Z <br /> 1.All calls for inspectfon shall be made 24 hours in advance- phone 259-8810. O <br /> 2.All work shall be performed in accordance wRh this permit and current City of Everett Design and <br /> Construction Standards and Speciflcations. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5565. H <br /> � <br /> O <br /> 'UOUC WORKi ��1{U/�T a <br /> NOT q�p�IR6� <br /> 3 V.__—�16!^. <br /> �ATE..__« , <br /> ACKNOVVLEDOEMENT OF CONDfT10NS <br /> ihe undersipned ownedeppl�ant ha�sby p�ses to hold and aew hartnlas <br /> the Clry of EveroN irom any and ell dalms for d�mapes,cosb,expenaas,or <br /> Approved lor ConsWction pete ceuses of ectbn thet may ubs becauae of InateAetbn nd m�kitanru of <br /> tM improvanent a otMr rlpM-of-wry ws heMo appMsd lor and firlhxapress <br /> to rertwve same upon notka lrom the Ciry and ro iaplas puhNc propa�ty <br /> demagad thereby. <br /> PINAL INSPECTION Date <br /> Approved as Constructed <br /> Signature of Applk.ant Dete <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIiHIN 180 DAYS OF�ATE PERMfT IS ISSUED AND THERFAFTER IS TO BE qLKiENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCEILED BY THE CfTY UPON ANY STOPPAGE OF WORK ON lHIS PRO.IECT OVER 90 DAYS WRATION. <br />