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i <br /> i <br /> � <br /> � � Date v�o���wo�..vs,m�„ <br /> �.:..� �:_.,,� niasoeo�.. <br /> Appllcatle ar <br /> 1D � PIJBLIC WORKS PERMIT `°°'""'°",�°° S __ <br /> � Tolal Foe � <br /> � y lmf Ppol Fee Pain 5 <br /> Ny� �iL' flaiance o� i 5 <br /> r2 y� Print or Type Only <br /> ��b <br /> ��� Plan Check No: E 27659 Z�p Phane <br /> Owner Appllcat.Date: 09/06/91 <br /> H G Job Addrs: 5321 EVERGREEN WAY <br /> O H Sepa Number: � <br /> (P�7�QJ Owner: LEIBSOHN, BOGUCH 6 CO <br /> 4t c7 Applicanl Proposed Uee: THRIFT SHOP Z�p Phone � <br /> � � Deec. of Work: <br /> LH TENANT IMPROVEMENT BOOOSF <br /> `'�y Descri6e Praposed Work JOB SET � <br /> . � OFFICE SET <br /> ty(~p APPRVD FOR PERMIT: DATE_/_I_ BY <br /> A � <br /> �� � <br /> �� .-- r. � Project Address(il known) <br /> Attach tour(4)copies oF Flans br pmposed work� Oraw to scale and note Ihe lollowing as applica6le: � <br /> • Properry Lines • Centerline o�street � <br /> • Outline and dimensions of all enisting and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utililies • Show measuremenls M <br /> W <br /> . DO NOT WRITE BELOW THIS LINE O <br /> �,�� —�,\ pERMITCONDITIONS <br /> + 1.All calls for inspecHon shall 6e made 24 hrs.in advance•phone 259•8810. � � <br /> C�', 2.All�vork shall be peAormed In accordance with this permit and c�rrent City of Everelt Design and Construction <br /> � � Standards and Specificalions. �. <br /> � � 3.Call Location,Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � �i <br /> +_ O I <br /> � ! �Ll/���[.GCO'�2�–'�- ��1a2m�C L"�fi1 �c.{�J/!r-L_�'I� <br /> 0 <br /> �� � <br /> _— �,, %`� � � <br /> I � O <br /> '; _e_ a <br /> � - <br /> �I� ACKNGV.'LEDGEMENT OF CONDITIGNS <br /> The undersigned owner/applicant horeby a9rees lo hold and save harm- <br /> � less lhe City of Everetl Irom any and all claims for damages, costa <br /> '_1=t expensea or causes of action iha� may arise hecause of installation <br /> and maintenance of lhe improvement or o�her right•ol•way use herelo <br /> applied lor and tuhher agrees to remove same upon notice Irom the <br /> - � - Approved for Construction Date Cily and to replace public property damaged lherehy. <br /> FINAI INSPECTION Date Date <br /> Appraved as Constr�cted Signalure ol Applicant <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STAqTED WITHIN <br /> ���� PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PEFMIT IS ISSUE� AND THEREAFTER IS �TO <br /> 3200CedarSireet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMiT MAY BE <br /> Everelt WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•BB10 PROJEC7 OVER 90 �AYS DUFATION. <br /> � � <br /> ,ix . <br />