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TYPE OR PRINT ONLY <br />^lication For <br />PUBLIC 1hJRKS PERMIT <br />Owner M <br />Appliwnt M <br />Describe Proposed Work <br />PRO�ECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Stieet <br />Everett, WA982U7 259-8810 <br />Plpan Check No: C 5/254/6 <br />APJobcAddreee: S1b29kVCKER AVE <br />Owner: LECHNER DWIGHT <br />Tenant: <br />� <br />Date _ <br />Pubiic Works Pertnit N <br />Bullding Pertnit N _ <br />Public Nbrks Fee S _ <br />SEPA <br />Propoeed Uee: SINCLE FAMILY RESIDENCE <br />Deec. of Work: <br />CONVERT EXISTING GARAGB AND BEDROOH TO <br />MASTfiR BEDROOM AND BATH <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Phone <br />Phone <br />Adach four (4) copies of plans for proposed work � Jrew to scale end note the followi��g if applicable: <br />•Property Lines 'Outiine and dimensions ot all ezisting and proposed structures on the lot •Exlsting and prt+posed utilities <br />'Centerllne of street •Indicate North 5how any proposed grading changes 5how measuremenis <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 perfortned in accordance with this permit and current Ciry of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�'UBUC N�ORKS �6pLu7 <br />�i0! AEOWIl1SIP <br />�v__�� <br />yATE__�! _9u <br />� , �w�_.. <br />Approved tor Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />� <br />O <br />,�A <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned awner/applicant hereby agrees to hold and save hartnless <br />the City of Everetl from any and all claims for damages, costs, ezpenses, or <br />causes o} action that may arise 6ecause of installation and malntenance af <br />the i:nprovement or other right-of-way use hereto applietl for and further agrees <br />l0 2move same upon notice from tha Cfty and to replace public properry <br />damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED B'f THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PEFMIT IS ISSUE� AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEf10N. THIS PERMIT MAY BE CANCELLE� BY ThIE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 �AYS DURATION. <br />