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�ate �. ' Public Worka Permlt s <br /> BIEq.Oept�_ <br /> Application ror <br /> PUBLIC WORKS PERMIT Pub7otalFeeFea s <br /> Leaf AppL Fea P+Id $ <br /> Balance Due S <br /> Print or Type Only <br /> Plan Check No: B 44174 SEPA <br /> Applicat.Date: 04/21/94 Phone <br /> Owner Job Address: 4809 EVERG EN WY � ip <br /> Owner: HGMA _ �OG�{G��� �J <br /> Tenant: �� <br /> � Propoaed Uee: RESTAURANT <br /> Deac. of Work: <br /> Applicant gEMpVE pND REBUILD EXISTING ANNEX �P Phone <br /> JOB `�T�m <br /> Describe ProPosed Work _ OFFICE SET — <br /> APPROVED FOR PERMIT: DATE__/_I_ BY <br /> - W <br /> Project Address(i( known) � <br /> Attach four(4) copies of plans lor proposed work• Draw lo scale and nole the following as applicable: � <br /> • Property Linas • Centeriine of street � <br /> • Oulline and dimensions of all exisNng and • Indicate North <br /> proposed struclures on the lot • Show any pr�posed grading changes <br /> • Existing and prnposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <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 peAormed in accordance wilh this permit and current City of Everetl Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location UnZarground Seraice 48 hrs.before/ou dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> O <br /> �Us N PI�KU`Miy�` �T � <br /> L!f � <br /> OY <br /> DATE � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The und�rsigned owner/applicant hereby agrees to hold and save harm• <br /> less �he City ot Everelt from any and all claims tor damages, costs, <br /> expenses, or causes ef action that may arise because of installation <br /> and maintenance of the improvement or other right-of•way use hereto <br /> applied for and further ,�grees to remove same upon notice from the <br /> Approved for Construction Dale Ciry and to replace publ�c property damaged thereby. <br /> FINAL INSPECTION Date � Date <br /> Approved as Construcled Signature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �Ar� PUBLICWORKSOEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 CederStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> EverelC WA 98201 CANCELLED BY THE CITY UPON ANl'STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 pROJFCT OVER 90 DAYS DURATION. <br />