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� � � <br />m�x <br />'�x�' <br />HD�', <br />H x H <br />�H� <br />"�+J H'i1 <br />V1 H <br />Hx t' <br />t+70� <br />Hl7 <br />OH <br />H�g <br />�� � <br />9H� <br />rCHH <br />ON <br />�a� <br />� � C+] <br />HO� <br />b' " � <br />Date <br />ApPlication Fo� <br />PI�BI..IC WOf�NC� P�RIIAIT <br />Print or?yF� Oniy <br />i:a.r, Ch2�Y; No: F 36�-'�76 <br />' -§p:l�r.a,. ^�.c.r: G��.,�ii�o� <br />JoL` P.dc,::&; '.•{D:! SF: EVERF"�7. <br />'��,rn2[: T:TANIC ASS!�� <br />-- Tenant: :^JtL4Ul12:'t F'cJN <br />Owner Propo:aed Us�: MEETING RCI.)'.4 <br />Desc. of o1orY.: <br />T.I. -� 1092Sf' <br />qpplicant <br />Descrihe Proposed �Nork <br />Project Address (i� known) <br />� <br />� Puei.cv:o�wsFc�mn+ <br />� oiaq r,c.�. . _ <br />Puei¢ Works Feo 5 <br />Tolal Fee <br />Lesf Apol ice PaiE $ <br />Baia�ce Due $ <br />SEPA <br />1�i.L 4�Y �Y3� <br />OFFICE SET JOP. SET_ <br />TP2AVD FOR PER11I'.: DATF. / � <br />— _r <br />� Phone <br />Attach lour (41 copies ol plans lor proposed woik � Draw to scale and nole thr following as applicable: <br />�1 Propeity Lines b Centerline of slreel <br />• O�Nine and dimensions o! all existing and •!ndicate North - <br />proposetl structv.res on :1e lot • Show any proposed grading chanpes <br />• Exislmg and praposed utilities • Show mezsuremenls <br />Phene <br />PERMITCO�:DiTIONS <br />•�s ` 1. All calls tor inspeclion shal! be made 24 hrs. in advance- phone 259•881 O. <br />!'�+ 2. All work shall be pedormed in accordance with this percnil and cur.e��t City of Everett Design ami Constr�.iction <br />; Standards aid Specilications. <br />' 3. Call Locatien Und�rground Service 4B hrs. before you dig. TOLL FREE NUIdBER 1•800•424•5555. <br />�U%' CL�L`r�'"'� �'Fti�r..�� J'l:t'i�ii{'�,.'.CL!.';/ <br />� <br />Appro�ed lor Gonstruction <br />FINAL INSPECTION Date <br />�pproved as Conslr�cted <br />PU�I IC WORKS DEPARTMENT <br />� 3200CetlarStreet <br />Everelt, WA 98Y01 <br />Phone:25�3�8810 <br />�1 � <br />i: <br />i,.� / + � <br />�� <br />ACKNOVvLEDGEAICNT GF CO�DITIONS <br />W <br />� <br />�w <br />M / <br />� <br />� <br />� <br />� <br />u <br />The urdersigned owner/nppiicant hereby agreee to holtl and save harm- <br />less the Cdy of Everett iwm any and all claims for danages, costs, <br />expenses. or causea of •r.ction that may arise because ol installation <br />and mainlenance of the improcement or other righbof-way use hereto <br />applied lor and lurther a9�ees ro remove same upos notice Irom the <br />Cily and to replace F��blic Froperty dama ,ed Ihereby. <br />Signa�ure of Applicant Date <br />WORK AUTHORIZE.i� BY TFII:.' P�RMIT MUST 9E STARTED WITHIN <br />i80 DAYS OF DA'iL PERMIT �F ISSUED AND THEREAFTER IS TO <br />BE DILIGENiLY PUBSUED TO COMPLETION. THIS PERMIT MAY 9E <br />CANCELLED BY THE: CITY U�C:� AN}' STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURAl10N. <br />