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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: C 49033 SEPA <br />Aoplicat.Date: 07/24/95 <br />Job Addrs: 1610 63RD ST SE <br />Owner: YAI SOPHAN <br />Owner Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Deac. of Work: <br />ADDITION <br />Applicant <br />OFFICE SET JOB SET <br />Describe Proposed Work _ APPRVD FOR PERMIT: DATE_/_/_ BY_ <br />Project Address (if known) <br />Public Works Parmlt e <br />Bldg. Dept e <br />Public Worse Fea S <br />Total Fee <br />Leas App: Fee Paid S -- <br />Balance Due S <br />Zip Phone <br />Zip Phone <br />Attach lour (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 40 hra. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />UBLIC <br />W NI• <br />EOUIREn <br />NOT <br />I Y / <br />SATE. -_Y 7 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />iZ <br />0 <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm. <br />less the City of Everett from any and all claims for damsyb% costs, <br />expenses, or causes of action that may arise because of InFlallation <br />and maintenance of the improvement or other right-of-way use hereto <br />_-. applied for and further agrees to remove same upon notice from the <br />Approved for Construction Dale City and to replace public property damaged thereby. <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />W�Ever <br />Ceder Street <br />Everett, WA 90201 <br />Phone: 259.8810 <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 15 TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />