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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Oniy <br />Plan Check No: <br />Applicat.Date: <br />Job Addresa: <br />Owner: <br />Tenant: <br />Yroposed Uae: <br />Deec. of Work: <br />PATIO ROOF <br />Applicant <br />B 49476 <br />09/13/95 <br />15i9 MCDOUGALL AVE <br />HAMILTON FORREST <br />FAMILY RESIDENCE <br />Describe Proposed �Vor1 AppROVED FOR PERMIT: DATE BY <br />_���— <br />Prolect Address I�f known! <br />Public Wa�xs Fce <br />TOITI Fee 5 <br />Less>oul Fnc PaiO $ <br />AttaGh �our�4) COpieS Ot plan5 �or prppu5ed wu�K � L,v; t0 5r.al�� ann nCle Ihe'o�luwing as anUlir.abie� <br />• Proper�y Lines • Centerline of Sireet <br />• Outline and dimensions o� all exishng and • Intlicate North <br />proposed struclures on Ihe lot • Snuw any c.roposetl gratlina changes <br />• ExiSiing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. Ali work shall be peAormed in accordance with Ihis permit and current City o( Everett Design and Construction <br />Standards and Specificationa. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-500-424•5555. <br />�.!BLIC 'vrOMKS PEpNIr <br />� y�'�9���UJI►Fn <br />�S <br />�� <br />rATE_ ,� _._---._._ <br />FINA� INSPECTION Date <br />Approved as Constructed <br />` PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everett, WA 98201 <br />Phone:259�BB10 <br />ACKNOWLEDCiEMENT OF CONDITIONS <br />Thv under��qned owner/auPlicant hereby agrees to hold and save harm� <br />less ;he City o� Ever^�1 Irom any and all claims for damages. costs. <br />e.penses. or causes ol action that may aris= because ol ins�allal:on <br />anA maintenance o! Ihe improvement or other right�ol�way use hereto <br />�aN�eC �or and lurther rgrees to remove same upon notice I�om Ihr, <br />O!� antl to replaca public property damaged Ihereby. <br />Siqnature ol Apphcan! Date <br />1NORK AUTHOR12E� BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEH IS TO <br />BE OILIGENTLY PURSUED TO COMPL[TION. THIS PERMIT MAY BE <br />CA^JCELLtU BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 D4YS DURATION. <br />