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Date <br />ApplicaUon �br <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />pwner <br />AppliCant <br />Describe Proposed Work <br />Plan Check No: <br />Applicat.Date: <br />Job Addrese: <br />Owner: <br />Tenant: <br />Proposed Use: <br />Desc. of Work: <br />CHANGE OF USE <br />B 48641 SEPA <br />06/19/95 <br />7207 EVERGREEN WY <br />DUESENBERG WILLIAM <br />DOLL—FIN DAYCARE <br />DAYCARE <br />— T.I. <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_I_ BY <br />PuoIIC Wo�ks Parmll • — <br />oioo. ooa. • <br />PuOhc Work� Fm S <br />Total Fao <br />lese AGo� Fee Pa�d $ <br />Balance Pua 5 <br />Phone <br />Phone <br />Projecl Address (if known) — <br />Attach four (4) copies of pla�s lor proposed work • Draw lo scale and nole the loibwing as applicable: <br />• Property Lines <br />• Outline and dimensions of all eaisting and <br />proposed structures on Ihe lot <br />• Existing and proposed uldities <br />� C�n�erline o( slreet <br />• Indicale North <br />• Show any propused grading changes <br />• Sh•.;w measurements <br />PERMIT CONDITIONS - <br />1. Ail calls lor inspeclion shall be made 24 hrs. ii� advanca- phone 259•8810. <br />2. All work shall be pedormed fn accortlance wdh Ihis permit and current City of Everetl Design and ConsVuction <br />Slandards and Specificalions. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•S00•424•555 . <br />�'UBNOfWREdU1RED MIT <br />2Y ` � if' ' .�.----^- <br />�+ATE /��/� <br />Approved for Constructio � <br />Dale <br />FINAL INSPECTION Date <br />Approved as Constructed <br />������ PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everett, WA 58201 <br />Phane:259-8810 <br />� <br />\/ <br />� <br />Y / <br />Q <br />� <br />ACKNOWLEUGEMENT OF CONDITIONS <br />The undersiyned owner!applicant hereby agrees to hold and save harm- <br />less the City ot Everetl from any and all claims lor damages, costs, <br />expenses, or causes ct action that may arise because of installation <br />and maintenance of the improvemenl or olher right•o(•way use herelo <br />applied for and further agrees lo remove same upon nolice trom the <br />Cily and to replace public properly damaged thereby. <br />Dale <br />Signature ol App�ican[ <br />80RDAYS OF DATE PERMIT SEISSUED AND HEF�AFTER IS 1'O <br />BE CILIGENTLY PURSUED TO COMPLETION. THIS PERti11T MAY BE <br />CA�7CEI.�ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />