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x <br />C H <br />"ilH N <br />Cn H <br />H <br />z <br />t� t7 <br />OH <br />�^gig <br />F-1 <br />> F3Cot <br />+1 <br />t HH <br />O t; ![[n <br />N <br />HOfit <br />Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: <br />Applicat.Date: <br />Owner Job Address: <br />Owner: <br />Tenant: <br />Proposed Use: <br />Applicant Desc. of Work: <br />TI <br />Describe Propol-ed Wol OFFICE SET <br />Pro,:-r Address (it known) <br />B 38864 <br />12/01/92 <br />2831 W MARINE VIEW <br />SOUND DT?,61rOSTICS <br />OFFICE <br />JOB SET <br />PUCLo Work* Peres e <br />Bldg Dept a — <br />Public Wo tut Fee $Total Fee <br />Les* Appt Fee Paid $ <br />Falance Due $ <br />SEPA <br />DR Zip Phone <br />APPROVED FOR PERMIT: DATE_ _/_ BY <br />Zip Phone <br />Attach four (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 existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />a Existing and proposed utilities • Show measurements <br />PERMIT CON D17IONS <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 48 hr& before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />PUBLIC WORKS PERMIT <br />NOT EOUIRED <br />BY_ <br />BATE 92i__ <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />WORKS DEPARTMENT <br />6LPUBLIC <br />3200 Cedar Street <br />Everett WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />InI <br />Z <br />0 <br />t� <br />Y / <br />0 <br />a <br />The undersigned owner/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 rightof-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged (hereby. <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 />