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Date <br /> Public Works Permit e <br /> Application For slag DePI.e <br /> PUBLIC WORKS PERMIT Kb;ot or1 ,Fee s <br /> LOSS APPt Fee Paid $ <br /> Print or Type Only Balance Due s <br /> Plan Check No: C 44081 SEPA <br /> Applicat.Date: 04/13/94 <br /> Owner Job Addrs: 625 58TH ST SE Phone <br /> Owner: GREEN ROSEMARY <br /> Tenant: <br /> Proposed Use: SINGLE FAMILY RESIDENCE <br /> Desc. of Work: <br /> Applicant ADDITION — RE—ROOF Phone <br /> Describe Proposed Work OFFICE SET JOB SET <br /> APPRVD FOR PERMIT: DATE_/_/_ By <br /> Project Address(if known) W <br /> Attach lour(4)copies of plans for proposed work• Draw to scale and note the lollowing as applicable: <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North <br /> Proposed structures on the lot • Show any proposed grading changes Cn <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shell be made 24 hrs.In advance•phone 259.8810. 7 <br /> 2.All work shell be performed In accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. z <br /> O <br /> 1 UBLIC WORKS PERMIT <br /> NOT REOUIRED <br /> BY ODATE /S <br /> a <br /> Seat See <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> lesi the City of Everett from any and all claims for damages, costs, <br /> expenses. or causes of action that may arise because of installation <br /> and maintenance of the improvement or other right•ol•way use hereto <br /> Approved for Construction — applied for and further agrees to remove same upon notice from the <br /> Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Dale <br /> PUBLIC WORKS DEPARTMENTWORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200Cader Street 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:259.8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Pnri IFCT r1VFR on DAYS 1111RATIn N. <br />