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� AOPlication For <br /> PUBLIC ' ORKS PERMIT °a; <br /> PUBLIC WORKS DEPARTMENT Public Works Pertnit N <br /> 3200 Cedar Street <br /> Everetl,WA 98201 259-8810 <br /> Building Pertnit N <br /> TYPE OR PRINT ONLY <br /> Public Nh+rks Fee$ <br /> Plpan Check No: B /55903 SEPA <br /> Owner ApJobcAddDeeee 33b11COLBY AVE — <br /> Owner: SOLIE FUNERAL HOME Phone <br /> T0i18i1t t <br /> Proposed Uee: FUNERAL HOHE ,i <br /> Applicant DeeC. of Work: � <br /> REPAIR 6 AEROOF OF EXISTINC ROOF INCLUDING Phone , <br /> NEW FASCIA & ROOFLINE � <br /> Describe Proposed Work _ oppicE sET <br /> JOB SET � <br /> APPAOVED FOR PERMIT: DATE <br /> ��_�_ BY � , <br /> � <br /> PROJECT ADDRESS(if known) _/ <br /> Attach four(4)cupies of plans for proposed work-Draw to;:cale and note the following it applicab�e: m � <br /> •Property Lines •Outline and tlimensions of all oxistin.3 and proposed strvctures on Ihe lot •Existing antl proposed utllities O <br /> •Centerline of street •Indicate North •Show any proposed grading changes •Show measuremenls <br /> DC� NOT WRITE BELOW THIS LINE � <br /> PERMITCONDITIONS: � ' <br /> 1. All calls for inspection shall be made 7.4 hours in advance - phone 259-8810. <br /> 2. AII work shall be performed in accordance with this permit and current City of Everett Design and O <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br /> xURLI� � <br /> ITORh�;��.^ O <br /> K�,� R a <br /> ���-�- <br /> �►.�t�, 1 yZ.�. . <br /> � � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agree;to hold and save hartnless <br /> the City of Everett from any and all claims for damages,costs,expenses,or <br /> Approved(or Consiruction Date causas of actlon ihat may arise Secause ol installation and maintenance of <br /> theimprovementorotherright-ol-wayuseheretoappliedlorandFutlheragrees ' <br /> to remove same upon notice from the City and to replace public property <br /> damaged ihereby. � <br /> ,�INAL INSPECTION Date <br /> Approved as Constructed � <br /> Signature of Applicant Date � <br /> WORK AUTHORIZED BY THIS PERAIIT MUST BE STAqTED WITHIN 180 DAVS OF DATE PERMIT iS�SSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEf10N.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />