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CApplleauon For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257•8810 <br />TYPE OR PRINT ONLY <br />Owner <br />Applicant <br />Describe Proposed Work _ <br />PROJECTADDRESS (if known) <br />Plan Chedc No.: <br />Job Address: <br />Owner: <br />Tenant: <br />Application Date: <br />Proposed Use: <br />Type of work: <br />B9909-014 <br />2423 MUKILTEO BWD <br />SUTHERLAND VAL <br />9/13/99 <br />SFR <br />CHANGE ROOF PITCH <br />Office Set ]ob SeL Fire/Planning Set <br />Approved For Pertnit: Date: By: <br />liai@ <br />Public Works Permit M <br />Building Permit M _ <br />Public Works Fee $ _ <br />Phone <br />Phone <br />Attach four (4) copies plans for proposed work • Draw lo scale end note the toliowing II applicable: <br />• Properry Lines • Outline and dimensions ol all existing and proposed stnrctures on the iot • Existlng and proposed utilitles <br />• Centerline ot street • Indicate North • Show any proposed grading chenges • Show measuremeMs <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls tor inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be performed in accordance wilh this permit end current City o1 Everett Design and <br />Construction Standards and Specifications. , <br />3. Cail Lxation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-4245555. <br />pprove or ons ruc ion a e <br />FINAL INSPECTION <br />Approved as Conswcted <br />Date <br />��I{iLIC WORKS r�RMla <br />rOf fillUlREi! <br />4Y—�,� <br />�AT�.----�– — <br />W <br />� <br />� <br />Y A <br />� <br />O <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplicant hereby agrees to hold aM save hartnless <br />Ne City of Everett Irom any end all claims for dameges, casb, expenses, or <br />causes ot action that may erise because oi instnllatlan and maintenance ol the <br />improvement or other right�of•way use hereto applied for and lurther eprees to <br />remove same upon nodce from the Ciry and ro roplece publk propeAy dem- <br />aged thareby. <br />pna re o p icen a e <br />WORK AUT110RI�D BY iHIS PERMR MUST BE STAFlTED WfTFiIN 180 DAYS OF DATE PEAMR IS ISSUEDAND hEREAFfER IS i0 BE OKIGENRY PURSUED TO <br />COMPLEIION. THIS PERMIT MAY BE CNJCELIFD BYiHE CRY UPON ANY SIOPPAOE OF WOPoC ON iHIS PFiQECTOVER 90 DAYS IX1FiAilON. <br />