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� �lication For . _.--- <br /> PUBLIC �ORKS PERMIT Date'� �iz<�» <br /> PUBLIC WORKS OEPARTMENT Public Works Permit q <br /> 3200 Cedar Street — <br /> Everett,WA98201 259-8810 Building Permit p__ 56001 <br /> TYPE OR PRINT ONLY Public Works Fee$ <br /> PACIFIC RETAIL TRUST 13000 114TH AVE SE 11208 BEI.LEVUE 980U4 4s1-9500 <br /> Owner Mailirg Address City Zip Phone <br /> OFFICE DEPOT CONTACT: ERIC KOCH 425-82,'-3282 <br /> Applicant MailingAddress City Zip Phone <br /> Describe Proposed Work T.I. AND EXTE''.IOR CANOPY UPDATE � <br /> � <br /> � <br /> PROJECT ADDRESS (ifknown) 10115 EVERGREEN WY � <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the following if applicat'e: � <br /> `Propehy Lines •Outline and dimensions of all existing and proposed structures on ihe lot •Existing and proposed utilities O <br /> •Centedine of sheet •Indicate North •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1. All calls for inspection shail be made 24 hours in advance-phone 259-8810. <br /> 2.All work shall be performed in accordance�vith this permit and current City of Everett Design and O <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> a � �; re� O <br /> l� f � � <br /> � a <br /> `�� : <br /> � <br /> � <br /> � <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save hamdess <br /> the City of Everett from any and all claims for damages,costs,expenses,or <br /> Approved for Construction Date ' — causes ol action that may arise because of installation and mainlenance o� I <br /> ihe impmvement or othzr right-of-way use herero applied}or and further agrees <br /> to remove same upon notice fro.�n the City and to replace public property <br /> damaged thereby. <br /> FiNAL INSPECTION Date <br /> Approved as Constructed <br /> Sionature of Applicant pa1e � <br /> 'YORK AUTHORIZED BY THI;,PERMI f MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGEN7lY PURSUED TO <br /> COMPLE710N.THIS PERMIT h1A1'BE CA�CELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />