Laserfiche WebLink
1PPlication For <br />IL`r. PUBLIC IrJORKS PERMIT °L <br />PUBLIC WORKS DEPARTMENT Public Works Permit p <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />Building Permit p _ <br />TYPE OR PRINT ONLY <br />Owner <br />Applicant <br />Describe Proposed Work _ <br />Public Works Fee $ <br />Plan Check No: C 60865 SEPA <br />Appl icat. Date: 11 / 18/98 Phone <br />Job Addreas: 9609 BELMONT DR <br />Owner: BROWN DOYLE/NANCY <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Desc. of Work: Phone <br />CONVERT GARAGE TO LIVING SPACE (FAMILY <br />ROOM) <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />PROJECT ADDRESS (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the fo;!owing if applicable: <br />'Property Lines 'Outline and dimensions of all existing and proposed struJures on the !ot •Existing and proposed utilities <br />'Centerline of street 'Indicate North 'Show any proposed grading changes 'Show measurements <br />Ju NU I WHI I E BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Cor.si:-;ction Standards and Specifications. <br />3. Call Loca,lon Underground Service 48 hrs, before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />Approved for for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />'UDLIC WORKS PEpMrr <br />ifREpUmEn <br />•ATE. <br />W <br />_/ <br />ca <br />O <br />z <br />0 <br />PM <br />C0 <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from nny and all claims for damages, costs, expenses, or <br />causes of action that may arise because of Installation and maintenance of <br />the improvement or other right-of-way use h,treto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant Date <br />AUTHORIZED BY THIS PERMIT MUST BE STARTED WITI IIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />-ETION. THIS PERMIT rJAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />