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�i r-i � <br />ay <br />,ozx <br />a H <br />aycn <br />H wy �' <br />y zH <br />�G C) <br />H� <br />� x0 <br />� H � <br />V1 H <br />Hx C <br />lTJ O � <br />HC <br />O H <br />'� c i C <br />H CTl O <br />ij] V (i <br />ay� <br />r z <br />d �' H <br />C� C7 f� <br />��� <br />z H C/� <br />H O C/� <br />Date_'z-SS�D <br />Application For <br />PUBLl�. WORICS PERMIT <br />Print or Type Only <br />�,.:,� _ �:.,.. �.. . , .. <br />a.:: :,, u : _�4/2479CL_ _— <br />PUDI c W orks Gee <br />�alalFce S <br />Lessaoo� FcePaia 5 <br />(?al:mr.r Duc $ <br />Alf W_ [•litchell BOS Hoyt Ave. Everett 98201 258-2572 <br />Owner MailingAtldress Ciry Zip Phone <br />Owner <br />App6cant Mailing Address City Zip Phone <br />Describe Proposed Work SFR — Roof modifiCatiOn fChattgg f._(a__f.�,dt to aable roofl <br />Project Address (if known) <br />F.ttach four (4) copies of plans lor proposed vrork - D�aw to scale and note the lollowing as applir,able: <br />• Property Lines • Centerline ot s�reei <br />• Outline and dimensions of all axisung and • Indicale North <br />proposed slructures on the lot • Shcw an <br />y propos^d gratlirq chan�es <br />O Eaislin� and proposed u�ilities • Sh��a� measuremr,nis <br />PERMITCONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pertormed in accordance with ihis permit and wrren! Ciry ol Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMHER 1-$00-4�24-5555. <br />��8�� � �.�� � �-� N� �- ,���«�o <br />Approved for Consiruction Date <br />FINAL INSPECTION Datc <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMEIJ'i <br />� 3200CedarStreet <br />Everett, WA 9�201 <br />Phana 259�Gt310 <br />�c�wQ. VV�'xr.� <br />S - �- "� _i <br />ACKNOWLEDGEMENT Gf CONDITIONS <br />The undersigned owner/applicant hereby agrees �o hold and save harm� <br />less ihe Ci�y ol Everetl Irom any and all claires lor domac�es. r,osis. <br />expenses, or causes of actinn Ihat may arise because of installation <br />and main�enance of ihe imprcvement or other ric�hbol-way usc hereto <br />applied br and further agrees to remove same upon notice Irom ihe <br />Cily and to replar.e public property damaged �hereby. <br />Signature of Applicant ;7��� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMITIS ISSUED AND THEREAPTERIS TO <br />BE DILIGENTLY PURSUED 70 COMPLETION. THI> PERMIT P.1AY �[ <br />CANG[LLED �V THE GITY UPON ANY STOPPAGf OF NJORI<ON THIS <br />PROJ[CT OVER 90 DAYS DURFl710N. <br />t_:.,5' a_..n 1.:-C . Y�k�,e� ,t:.'.,�:�.,.x .�� ,��..-..��-.1�^� :.:^s..�fStas.�..:,,7,f..sK.Y:.-e,�x�:�+.�r�t�.r'f'^"G+-h- _ . -'�" . . S ..� . e�.�_�-«. r, <br />1 . � •,t <br />,:=L. .__�.. .�'.:r. ' _:... .;ri:�t,;_" �. <br />.,,..:ti�. _.,....__ <br />