Laserfiche WebLink
Date <br />Appl(cation For <br />PUBLIC WORKS PERMIT <br />Prinf orType Only <br />Owne� <br />Applicant <br />Describe Propcsed Work <br />Project Address (if known) <br />IPUGIIe Worh� Parmll • <br />Biep. Dapt � � <br />PUE�it WOAs Faa <br />To�U Fae i -� <br />Leie App� Fee P�iE s- <br />Bebnca Dua S <br />Plpan Check No: H 4/208/8 SEPA <br />APJobcAddrees: 22bZOLYMPIC HLVD <br />Owner: MASONIC LODGE <br />Tenant: <br />Propoeed Uee: ASSEMBLY HALL <br />Desc, of Work: <br />CHANGE OF USE — T.I. — p]�yTITION WALLS TO <br />ENCLOSE KITCHEN, MEETZNG ROOMS, CLOSETS <br />OFFICE FET—�JOB SET <br />APPROVED FOR PERMIT: DATE��_ <br />Attach four (4) copies of plans for proposed work - Draw to s�ale and note the �ollowing as applicable: <br />� Property Lines <br />• Outline and dimensions of ell existing and <br />proposed structures on the lot <br />• ExisNng and proposed utllities <br />� Centertine of street <br />• Ind(cate North <br />• Show any proposed grading changes <br />• Show meesurements <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. All work shell be peAormed in accordance with this permit and current City of Everett Design and Construction <br />Stendards end Specificationa <br />3. Call Locatlon Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-$00-424-5555. <br />PUBLIC WORKS PEqMIT <br />NOT REOUlRED <br />BY � <br />DATE % �l/ ' <br />Approvetl for Construction <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPAFTMENT <br />3200 Cedar Street <br />EveretL WA gB201 <br />Phone: 259-8810 <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett trom any and all claims for damages, costs, <br />expenses, or causes ol 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 trom the <br />City and to replace public p�operty damaged thereby. <br />Signature ol Applicanl Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />iB0 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTEF 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 />