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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 />Project Address (if known) <br />Plan Check No: B 44981 SEPA <br />Applicat.Date: 07/22/94 <br />JJob Address: 7621 BEVERLY LN <br />Owner: EVERETT SCHOOL DISTRICT <br />Tenant: EVERGREEN MIDDLE SCHOOL <br />Proposed Uee: SCHOOL <br />Deec. of Work: <br />LOCATION/PLACEMENT OF PORTABLE CLASSRM <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Public Work, Permit e <br />Bldg pool. a <br />Public Work, Fee S <br />Total Fee <br />Lea ApplFee Paid 5 <br />Balance Due S <br />Attach four 14) copies or plans lot proposed work - Draw to acai,t •.Inn note the, 'ollowing 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 />• Existing and proposed utilities • Show measurements <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 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 hrs. berore you dig. TOLL FREE NUMBER i 800.424.5555. <br />PUBLIC WORKS PERMIT <br />NOT 5EOUIRED <br />BY <br />OATE 7 LS 9 <br />Approved for Construction Date <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />0 PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />177 Everett, WA 98201 <br />11_.,... ncn o.1M <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />O <br />Y <br />O <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 />t expensesor causes of action that may arise because of installation <br />-!- and maintenance of the improvement or other right-of-way use hereto <br />appt:ed for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />AUTHORIZEDWORK PERMIT WITHIN <br />180 DAYS OFF DATE PERMIT IS ISSUED AND HEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />non -CrT nvco on nava ntIRAT10N. <br />