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Date <br />Application For <br />PUBLIC WORKS F�ERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed 1 <br />Plan Check No: B 42497 SEPA <br />Applicat.Date: 10�27/93 <br />Job Address: 68 3 EVERGREEN WAY <br />Owner: MILES HOLLEY <br />Tenant: CRISIS PREGNANCY CENTER <br />Proposed Use: OFFICE SPACE <br />Deac. of Work: <br />FIRST FLOOR TENANT IMPROVEMENT <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Project Address (if known) <br />Zip <br />Attach four (4) copies ol plans lor proposed work - Draw to scale and note ihe lollowing as applicable: <br />• Property Lines <br />• Oulline and dimensions ot all exisling and <br />proposed structures on the lot <br />• Ezisting and proposed utilities <br />PUEIIc Wo�ka Permli • <br />BIdB� Onpl.• <br />Pu61i[ Wprks Poa <br />Total Feo $ <br />Less Appl. Feo Pald S <br />6alnnco Due $ <br />• Centerline ol street <br />• Indicate North <br />�1 Show any proposed grading changes <br />• 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. AI� 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. belore you di{�. TOLL FREE NUMBER 1•800•424-5555. <br />`�'����� WOHKS PERMI7 <br />NOT REOUIRED <br />eY .Q <br />7AT // 3 �3 <br />Approved tor Construction Date <br />FINAL INSFECTION Dale <br />Approved as Construcled <br />����PUBLIC WORKS DEPARTNENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�8870 <br />r <br />��������/ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />_ v <br />� <br />O <br />� <br />v / <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less lhe Ciry ot Everell from any and all claims tor damages, costs, <br />expenses, or causes of action ihat may arise because of inslallation <br />and maintenance of ihe improvemenl or other right-ot•way use hereto <br />applied for and furiher agrees to remove same upon notice from the <br />Cily and to replace public property damaged Ihereby. <br />Signature of Applicant Date <br />WO(;K AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1H0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS �URATION. <br />