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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check Nos B 43103 SEPA <br />Owner Applicat.Date: 12[28193 <br />Job Addreees 6720 ERKSHIRE DR <br />Owner s CARRELL CHAFtLES L <br />Tenant: <br />Vueuc woti. Permn . <br />BIOp D�O� � - <br />Pu01¢ iVorM� iu = <br />Tol�l f�� <br />l�i��DOi ��� P�id s <br />B�I/M� Du� a <br />i Phone <br />Applicant — Propoeed Uee: S2NGLE FAMILY RESIDBNCE , Phone <br />Deec. of Work: <br />CHANGE CARAGE TO FAMILY ROOH — UI6 DOWN <br />3'3" FAOM EXISTING DIRT FLOOR AND ADD 12" <br />Describe ProOosed Woik _ OFF2CE SET JGB SET <br />AP?ROVED FOA PERMITs DATE_/_/_ BY <br />Project Addresa (il known� <br />AttaCh lour (4) co0�es of plana for proposed work � Draw lo ecale and note the lollowing as applicable: <br />• Property Linas • Centerline of ciree� <br />• Oulline and dimansions ol ell e�isting antl • Indicate Norih <br />proposed slructures on Ihe lot • 3how any proposed p�ading changes <br />• Existing anE proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />�. All calis lor Inepection ahall be mada T4 hra. In advance • phone 259•8810� <br />2. All work shell be pedormed In eccordance wifh thia permit end current City of Eve�eti Desipn and Constiuction <br />3tandarda and Specificatlons. <br />3. Call Location UndergrounA Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />PUBLIC WORKS PERMIT <br />NOT REOUIREO <br />BY <br />DATE 3 9 � <br />Approvetl loi Conslruction Date <br />FINAL INSPECTION <br />qpproved as ConstructeA <br />� PUBLIC WORKS DEPANTMENT <br />'���3200 CeAar Sireel <br />Everell, WA 98201 <br />Phone�.259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />F- <br />� <br />� <br />O <br />The �ndersigned owner/applicenl hereoy aqrees lo hold and save harm� <br />less Ihe City ot Everell Irom any and ali claims lor damapes. coats. <br />p■pen5es, or causes ol ection that may arisa hiCause ol Inalallation <br />and maintenance of the improvement or olher righl�ol�wey usa hereto <br />appGed lor and Iwther agrees to remove same upon nolice Irom fhe <br />City and to replace pubhc p�operly damaped thereby. <br />Siqnalure ol Applican� De�e <br />WORK AUTHORIZED BV THIS PERMIT MUST 9E STAHTED WITHIN <br />1B0 DAYS OP DATE PERMIT IS '��3UE0 AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS FERMIT MAV BE <br />CANCELLEO HY THE CITV UPON ANY STOPPAGE OF WOkK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />