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Date <br />Applicalion r or <br />PUBLIC WORKS PERMIT <br />Pr,nt or Type Only <br />Owner <br />Applicant <br />Plan check No: <br />Appllcat.Date: <br />Job Address: <br />Owner: <br />Tenant: <br />Proposed use: <br />Desc. of Work: <br />CONVERT GARAGE <br />OFFICE SET <br />C 40592 SEPA <br />05/13/93 <br />628 61ST ST <br />DENNISON RICKIE K <br />SINGLE FA.:ILY RESIDENCE <br />TO BDRM/BATH <br />JOB SET <br />Describe Proposed Work APPROVED FOR PERMIT: DATE_/_/_ BY <br />^•ojec: Address (if known) <br />PWIC Wdrxe Perms <br />aldp Dell. e <br />PubLc Won e Fee <br />TOW Fee S __ <br />Loa APdL Fee Pbd S -� <br />etitece Due S__ <br />Phone <br />Zip Phone <br />Attach lour (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 exist'ng and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measuremonts <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. In advance - phone 259.8810. <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 40 hrs. before you dig. TOLL FREE NUMBER 1-800.424.5555. <br />PUBLIC WORkS PERMIT <br />NOT REQUIRED <br />B Y i <br />DATE / <br />Approved for Construction Dete <br />FINAL INSPECTION Date <br />Approved As Constructed <br />PUBLIC WORKS DEPARTMENT <br />Streat <br />0200 Ceder Street <br />IO&L, Everett, WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />z <br />O <br />The undersigned owner/appllcant 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 notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Dale <br />WOf K AUTHORIZED BY THIS PERMIT MUST BE STARTED WIIHIN <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 />