Laserfiche WebLink
Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Plan Cnecx No: C 46bb4 <br />Print or Type Only Applicat.Date: 06/21/95 <br />Job Address: 301 MADISON ST <br />Owner: SMITH RAYMOND <br />Public Works Permit e <br />Bldg. Dept. s <br />Public Works Fee $ <br />Total Fee <br />Less APpr Fee Paid $ <br />JC:PA I Balance Due $ <br />Tenant: <br />Proposed Use: SINGLE FAMILY RESIDENCE <br />Owner Desc. of work: <br />ADDITION OF MASTER BATH <br />OFFICE SET JOB SET <br />Applicant <br />APPROVED FOR PERb1IT: DATE_/_/_ BY <br />Describe Proposed Work . <br />Project Address (if known) <br />Zip Phone <br />Zip Phone <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following 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 <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259-881 O. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424-5555. <br />-,UBLIC WORKS PERMIT <br />Nor REOUIREn <br />3Y <br />DATE <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />CLPUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less 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-of-way use hereto <br />applied for and further agrees to remove same upon nctice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS .TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />