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Date <br />Applitellon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />Pro�uct Address (il knownl <br />��rn�,H '�.,F�� ur�d�� <br />� <br />Pub��c Warx� Pa�mi1 • <br />Biaq Oap� � _ <br />pvpLr. Werh� Fes <br />To1111 Fef s <br />Leta �oo� Fee Pu� S <br />Ba�ancaDue 5 <br />� 30 ,? 'i L-. E J! ii )r1 �C U✓� Y <br />Plan Check No: C 49828 SEPA <br />Appllcat.Dates 10/19/95 <br />Job Addre: X <br />Owner: DEPT OF TRANSPORTATION <br />Tenanti WA STATE PATROL <br />Propoeed Uees OFFICE <br />Deec. of Work: <br />PLACE MODULAA OFFICE BLDG P.T REST STOP FOR <br />USE BY STATE PATROL <br />OFFICE SET JOB SET <br />APPRVD FOR PERMIT� DATE_/_/_ BY <br />Attach lour (4� copies ol plans loi proposed work � Draw lo sr.,de anA note Ihe lo�lowing as applicab�e; <br />• P�operty lines <br />• Outline and dimensions ol all e■isting antl <br />proposPd slructures on Ihe lol <br />• Existing and proposod ulilities <br />• CenterGne ol slreel <br />• Indicale North <br />• $how any proposeA grading changes <br />• Show measuremenis <br />Phone <br />Phone <br />PEFMIT CONDITIONS <br />1. All cal�s for inspection shall be mndn 24 hrs. in advance - phone 259•881 O. <br />2. All work shall be peAcrmed In eccordance wlth this permit and current City of Everett Deslpn and Consiructlon <br />Sfandards end Speciflcatlons. <br />3. Call Location Unde�ground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />�ua�rc wonKe Pfil1NI� <br />r;oT aE�=p <br />�Y <br />�yATE. Z,7 !- <br />Approved for Consiruction Dale <br />FINAL INSPECTION Date <br />Approved as Conshuctod <br />�PUBLIC WORNS DEPARTMENT <br />3:00 Ceder Street <br />Everett, WA 9B201 <br />Phone:259•BB10 <br />��S�w�.- 2a�.�,-u�i�_ <br />p�K�' <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />_ I <br />The undersigned owner/applicant hereby agrees to hold and save hnrm• <br />less Ihe Cdy ol Everett Irom eny and al� claims (or Oamages. cosls. <br />e■penses. or causes ol action that may arise because ol inslallation <br />and ma�ntenanr.e ol ihe Improvemenl or other righl-ot�way use here�o <br />apn��P�1 lo� and lurther agrees to remove sanie upon notice irom Ihe <br />C�ty anA to replace p�blic property damaged Ihereby. <br />Signalure ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1A0 DAYS OF DATE PERMIT IS ISSUED �N7 (HEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPI.C-TION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PRO,IECT OVER 30 DAVS DURATION. <br />