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� <br /> Date <br /> Publie Werkt Parmll• <br /> Application For ema.oeo�.• <br /> PUBLIC WORKS PERMIT P����cWorw�Fee <br /> To1al Fea S <br /> �����OC�f�e P�Ia S <br /> Print or Type Only e.�.��.o�. s <br /> Owner ApplicatCDatec 034/28%94 Zip Phone <br /> SEPA <br /> Job Addreee: 1416 ROC!(EFELLF.R AVE • <br /> . Owner: BOLAND CAL & HE�DI <br /> Tenant: <br /> Applicant Deec�ofdWork; SINGLE FAMILY RESIDENCE Zip Phone <br /> CHANGE AOOF SLOPE AND EXTEND OVER EXISTING <br /> DECK AND ENCLOSE NEW DINING AREA <br /> Describe Proposed W� OFFICE SET <br /> JOB SET <br /> APPROVED FOR PERMIT: DATfi_/_�_ gy -- <br /> W <br /> Proiect Address(il known) � <br /> Atlach faur(4)copies ol pians for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centeriine of street � <br /> • Outline and dimensions of all exisUng and • Indicate North <br /> proposed structures on the lot • Show any proposed grading cnanges <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•881 O. � <br /> 2.All work shell be performed In accordance with this permit and current Clty of Everetl Design and Construction <br /> Stenderds end Specifications. <br /> 3.CaII Locatlon Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> O <br /> PUBLIC WORKS PERMIT � <br /> NO,�T REOUIRED � <br /> BY�' �� <br /> DATE � , O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 'fhe undersigned owner/applicant hereby egrees to hold and save harm• <br /> less the Cily of Everett irom any and all clalms lor damages, costa <br /> ezpenses, or causes of action that may erise because of Installation <br /> and maintenance of the improvemenl or a,her righbohway use hereto <br /> Approved lor Construclion Oate applied for anC further agrees to remove same upon no;ice Irom the <br /> City and lo replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conslructed Signature of Appiicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WiTHIN <br /> 3200CedarSlreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-BA10 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> nnn irrT rflr�n �n �IAVS f����7nTl(1�� <br />