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4 <br /> N <br /> n �° <br /> 9 � � Dd1e ��t' t� 'ti � Pum�cwanuvermn• �� , <br /> N � � APPlieationFor ama.�eo�a .��n/._7-}� <br /> ° � ° PUBLIC WORKS PERMIT PuoircWoik�Fea ' <br /> �p N M7 lolalFee s <br /> V1 M <br /> H � Le�t Appl Fw Pa1E S <br /> 6 <br /> t'7 BU�nce Oua S <br /> o � Print orType Only <br /> Q ��� �d <br /> r�i � '" Plan cnecx No: �t .f01l4 ��rp <br /> � y Appllcat.Date: 03/26/92 �. <br /> Job Addreee: 3202 COLBY AVE Zip Phone <br /> r+ Owner Owner: SALAMA, WILLZAM DR <br /> � N H Tenant: <br /> o N Propoeed Uee: MEDICAL OFFICES I <br /> � � r Deec. of Work: , <br /> y � Applicant ZENANl' IMPROVEMENT 1700 SF Z�P Pha^a I <br /> O N <br /> OFFICE SET J06 SET <br /> Describe Proposed Work I <br /> APPROVED FOA PERMIT: DATE_/_�_�gy <br /> W <br /> Proiect Address(il known) � <br /> Atlacn four(4)copies of plans lor proposetl work•Draw to scale and note the following as applicable: � <br /> • Properry Lir��.s • Centedine ol stree ♦^ <br /> • Outline and dimensions of all existing and • Indicate North V� <br /> proposed structures on t�e lot • Show any proposed grading changes <br /> i�� ,� • Etisting and proposed utilities • Show measurements wA <br /> � 00 NOT WRITE BELOW THIS LINE � <br /> 1 . PERMITCONDITIONS O <br /> 1.All calls lor inspectlon shall be made 24 hrs.in advance-phone 259•8810. � <br /> '�� 2.All work shall be performed in aCcordance with ihis permit and wrreM Cily ol Everetl Design and Construction <br /> � � Standards end Specilications. <br /> � . <br /> , 3.Call Location Undergmund Service a8 hrs.before you dIq.70LL FREE NUMBEH 1•800•424•5555. . � <br /> i . <br /> j . ` � � <br /> �� � <br /> �(�'�i-Pw C✓GzlE-'_��1ii:�n�� i�N�ciyco,ua✓� <br /> I 6 � <br /> � <br />� �i �� > i � , . � <br /> �� <br /> O <br /> � _�_� a <br /> �_1 � ACKNOWIEDGEMENTOFCONDITIONS <br /> � <br /> . The undersignetl owner/applicant hereby agrees to hold and save harm� <br /> - less the Cily of Everett Irom any and all clnims for damages, costs. <br /> expenses, or causes of action ihat may arise because of installation <br /> and maintenance ol the improvement or other righFof-way use hereto <br /> applietl lor and �urther agrees lo remove same upon notice Irom Ihe <br /> Approved lor ConSituclion � �ate City and to replace public property damayed Ihereby. <br /> FINAL INSPECTION Date <br /> Approvetl as Consiructed Signalure of Applicant Date <br /> � Pl%3LICWORKSDEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED�WITHIN <br /> 32J�7CetlarStreet 180 DAYS OF DATG PERMIT IS ISSUED AND TNEREAFTEP IS TO <br /> � Evr.ro4 WA09201 BE DILIGENTLY PURSUED TO COMPLETION.TH!^, P��t.11T MAY BE <br /> Phone:259�8910 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />