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Oate _ � P����wo,..F.,..: . __ <br /> AppliGation For � ewo.o•o�. <br /> PUt3LIC WORKS PERMIT ��KWorkaFN <br /> Tolal Fsa 8 _ <br /> Plan Chack No: B 46999 SEPA ��asAOD�fnP�iC S <br /> Printo►TypeOnly Applicst.nate: 02 13/95 e+rM.o�. b _ <br /> Job Addre: 201 ADAMS AVE <br /> Owner: WALKER JOANNE <br /> TeI1aI�t t <br /> Proposed Vee: SINGLE FAMILY RESIDENCE <br /> Deac. of Work: <br /> Owner ROOF PITCH CHANGE Zip Phone � <br /> OFFICE SET_ JOB SET <br /> ADG��ant APPRVD FOR PBRMIT: DATE_/_/_ BY 2ip Phone <br /> Crscribe Proposed Work __ <br /> W <br /> Projeet Address(if known) � <br /> Attach four(4)copies of Plans for proposed work•Draw to scale and note the foYlowing as apD��cable: � <br /> • Proparty Lines • Centerline of slreeN � <br /> • Outline tetl dimensions of all existing and • Incyiaale North <br /> proposed struetures on the lot 7 Show any propose�d pradinq chanqes <br /> • Existiog and proposed utilitias • Show measurementa � <br /> � DO NOT WRITE BELOW'fHIS LINE O <br /> PEpM1T CONDITIONS <br /> 1.All cails tor inspeetion shall be made 24 hrs.in advance•phone 259-881 O. � <br /> 2.All work shall be pertormed fn aecordance wNh thin permit and current City of Everett Deaign and ConetNction <br /> Standards and Specificationa <br /> 3.Call Locallon Underground 3erviee 48 hra beforo you di¢TOLL FREE NUMBER 1-800�4245555. <br /> � <br /> N� �b�� u���� �� � ,�,�,� O <br /> /?���- � <br /> z/�3/�s p <br /> a. <br /> ACKNOWLEOGEMENT OF CONDITIONS <br /> The unAersigmed nwner/applicant�eroby aqroxt to hold end seve harm- <br /> less the Ciry of Evered trom any and atl claims fw Camaqea, costs <br /> expenaes, or cauar.s of aetion that may arise beeauae of Mstattatlon <br /> end maintenxnce oY IMe Impr�vement or otfier rig�t-of-way use rerct.� <br /> apD��etl for and further agreea to remove samt upmn notiee from the <br /> ADP�a�ad�lor Constructbn Date Ciry and to repla�ce public property damaqed ihereby. <br /> FINAL INSPECTION Date _ <br /> Approve0 as Constructed Signature of Applicant Date <br /> PUBLIC WQRKSDEPARTMEN7 WORK 4UTHGA12ED BY TMIS PERMIT MUST BE STARTEU WITHIN <br /> 3200CedarStreet 180 DAl'S OF DATE PERMIT IS ISSUED AND THEREAFTEq IS �TO <br /> Everott.WA98201 BE DILIGENTI.Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:25&8870 CANCELLEO!3V THE CITY UPON ANY STOPPAGE OF WORK ON TMIS <br /> PROJECT OVF3R 90 DAVS DURATION. <br /> I <br /> � <br />