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Date- <br />,Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />Plan Applicatck No: B 36668 SEPA <br />Date: 05/07 /92 <br />Job Addrs: 3201 ROCKER AVE <br />Owner: PRIME NORTHERN <br />Tenant: BB ONYX <br />Proposed Use: DINING/COCKTAIL LOUNGE <br />Desc. of Work: <br />ENCLOSE EXISTING PATIO <br />OFFICE SET JOB SET__ <br />APPRVO FOR PERMIT: DATE_/_/_. BY <br />r <br />ubilc Works Permit e <br />Bmy. DdPt e <br />Public Works Fee $ <br />Toler Fee <br />Less spot Fee Paid S <br />Bell.. Due $ <br />ne <br />W <br />Project Address (if known) IMM <br />Attach four (4) copies of plans for proposed work, Draw to scale and note the following as applicable: <br />• Property Lines • Lunterline 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 />DO NOT WRJE BELOW THIS LINE O <br />PERMIT CONDITIONS <br />C� 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 />1 Standards and Specifications. <br />3, Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />1 <br />soft sees, O <br />l <br />a <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT O- CONDITIONS <br />The undersigned owrer/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 notice from the <br />City and to replace pubic 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 />