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� - - i <br /> „� . <br /> ' PubliC Wo�ka Perm�t• <br /> Date <br /> oiaa.oeo��• <br /> Apptication For <br /> PUBLIC WORKS PERMIT PuOi�cWoi4sFee <br /> ToteiFee S <br /> r� H Lef3P0o�Fea Gaid S <br /> l']�� <br /> Balanca0ue S <br /> �p�x Print or Type Only <br /> q H ' <br /> 9 H V� <br /> H �� ?lan Check No: C 37488 SEPA <br /> y H Applicat.Date: 07�23/92 phone <br /> �C C� pw�ef Job Addreas: 10 15 MERIDIAN AVE . <br /> H� Owner: SANDAGO DAVID <br /> Tenant: <br /> � y H Ptoposed Uae: SINGLE FAMILY AESIDENCE phone <br /> xt'� Desc. of Work: <br /> x 3 APP������ 608SF ADDN / REPLACE WHOLE ROOF (NEW <br /> [�7 O C�r1 TRUSSES) <br /> H <br /> O �-+ <br /> H �C Describe Proposed lVork _ OFFICE SET JOB SET <br /> O <br /> ,n„ n ppPROVED FOR PERMIT: DATE__/_I_ BY <br /> r H� -- � <br /> N � <br /> ~ Project Address(it known) <br /> G ❑ � <br /> C] C y <br /> 3 [s1� Attach lour(4)copies ol plans for proposed work•Draw to scale and nole the lollowing as applicable: � <br /> : • Cenredine of street <br /> z y y • Property Lines • Indicate North <br /> H O V� • Outline and dimensions ol all existing and � Show any proposed grading changes <br /> proposed structures on Ihe lot � Show measurements M <br /> • Existing and proposed utilities W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS ^ <br /> 1.All calls for inspeclion shall be made 24 hrs.in advance•phone 259-8810. <br /> '�, � 2.All work shall be perlormed in accordance wilh this permit and turrent City of Everett Design and Construction ♦ <br /> Standards and Specifications. � <br /> '�; 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800-424•5555. <br /> � . O <br /> �� � ��.(�, lc��^/%� �. . ( � '� ��� � <br /> 1 L � �� ,'c �-f' . � � _<< . �/-/�� J <br /> �•s �� ) ��� ; � <br /> �e. N <br /> 1 (� O <br /> a <br /> �,-� <br /> ACKNOWLEDGEMENT OF GONDITIONS <br /> '� The undersigned owne�/applicant hereby agrees lo hold and save harm• <br /> �� less the Cily of Everett Irom any and all claims lor damages, costs. <br /> expenses, or causes ol action lhat may arise because ol inslallation <br /> and maintenance ol Ihe impwvemenl or other righl-obway use hereto <br /> applied �or and lurther agrees to remove samc upo� nolice Irom ihe <br /> � Approved for Consirudion Date Ciry and to replace public property damaged thereby. <br /> FINAL INSPECTION Date Date <br /> ApProved as Consir�cled Signalure ol ApplicaN <br /> WORK AUTHORIZf_D BY THIS PERMIT MUST RE STARTED WITHIN <br /> I�r� PUBIICWORK50EPARTMENT 180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200Cedar Sireel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everelt,WA 90201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonc:259�8810 PROJECT OVER 90 DAYS DURAiION. <br /> _ . ` <br />