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~(-�a-Zq -S <br />Date <br />APPNcetion For <br />PUBLIC WORKS PERMIT <br />Print Or Typ@ Only Plpan Check No: B 41534 SEPA <br />APJobcAddreee: 38�44GRAND AVE <br />Owner: ROBINSON COLLEEN <br />Tenant: <br />Owner propoeed Uee: SINGLE FAMILY RESIDENCE <br />Deec. of Works <br />HOUSE ADDN <br />Applicant <br />Deacrlbe proposed Wark <br />Project Addresa (if known) <br />PuEllc Work� Permil • <br />eiea. Dapt. � _ <br />Pueuc worx� F« <br />Totai Fse i ��- <br />LeuApplFeaP�iC i,�,�- <br />B�I�nce Due S _ . <br />Z�P Phone <br />OFFICE SET JOB SET <br />Z�P Phone <br />APPROVED FOR PERMIT: DATE_/_�_ gy <br />Athch four (4) copiea of plans for proposad work • Draw to scale and note the followinp as applicable: <br />� Property Llnes <br />• Outline and dimensions of ell exieting and <br />proposed atructures on tha lot <br />• Exislinp and propoaed utilitlea <br />• Centerline of atreet <br />• Indicate North <br />• Show any proposed prading chengeg <br />• Show measurementa <br />PERMIT CONDITIONS <br />1. All calls for inapectlon ahall be metle 24 hre. in advence - phone 259�881Q, <br />2. All work eh�ll be peAormed In axordence with thia permit and current City of Everett Desipn antl Conatruction <br />Stenderds end Speciticetlone. <br />3. Call Location Underpruund 3ervice 48 hre. before you dig. TOLL FREE NUM9ER 1-800�4Q45S55. <br />p�s��� M�ORKS PERMIT <br />N�T OUIREO <br />BY <br />OATE y� <br />Approved f�x Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />�PUBLIC WORKS DEPAHTMENT <br />3200 Cedar StreSt <br />Everelt, WA 98201 <br />Phone:259•&B10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold end save herm- <br />less the City ol Everett Irom any end all claims for dameges, costs, <br />expenses, or causes ol action thaf may arise becausa of installatlon <br />and maintenance of the improvement or other right-of•way use hereto <br />applied for and further acrees to remove same upon notice trom the <br />City and to replace public p�operty tlamaged thereby. <br />Signature of Applicant Dete <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WI7HIN <br />780 DAYS OF DATE PERMIT IS �SSUED AND THEREAFTER IS �TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJEf'T OVEF 90 DAYS DURATION. <br />