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Date 6/5/95 <br />APPlication F�or <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�ul <br />Pubbc Worlu Perm�t • <br />eiaq. oeo+. • 48503 <br />PUEIic WaAb Fee s <br />Ta�al Fee <br />Less 40G�� Fne Pa�E S <br />Belance Oue �1 <br />Sang M Kim 8308 Frederick P1 Edmonds 98026 774-5365 Pnone <br />Owner Mailinc Ardress ���Y Z'p <br />Pacific Building Supply (Howard Heath) 353-2421 _ <br />,,,�;,,�„� Ms�hnc7 Address City ZiP Phone <br />Describe Proposetl Work Inetall_modular office __ <br />9901 Everttreen Wy <br />Prolect Address lif known! <br />Attach four �4) coples of Plans fo� proPosed worn � Drav.� to scal�� a;�d ncte the fo�lowing as apVficable: <br />• Property Lines <br />• Outline and dimensions of all exishn9 and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />� Indiwte Norih <br />• Fhow any proposed gratlinq changr.s <br />• Show meas !•?ments <br />PERMIT CONDITIOYS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259$810. <br />2. All work ahall be performed in accordence with this permit and current City of Everett De=ign and Construction <br />Stendarda and Specifications. <br />3. Call Location Underground Service 4B hrs. betore you dig. TOLI fREE NUMBER 1-800�4245555. <br />�CI � `j- Ii G �/OY�("T %Pi,��'l�� ITi�p�Jil'� <br />r� <br />G�,��! !%1!��` <br />�/Z/�S <br />Approved icr Constr icti ;n DTte <br />FINAL INSPECTION � Date <br />Approved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cadar Street <br />Everett WA 98201 <br />Phone: 25&8810 <br />ACKNOWLEDGEMENT OF COND�TIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />7he undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Cfly o1 Everetl irom any and all ciaims for damages. coats. <br />expenses. or causes of action that may arise because of inslallation <br />and maintenance nf the improvement or other right-ohway use hereto <br />ap�,i�rd lor and further agrees lo remove same upon notice irom the <br />C�!y antl to replace public property damaqed thereby. � <br />Signature of ApPiicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAi.�ED WITHIN <br />t80 �AYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS �TC <br />BE DIIIGENTLY PURSUED TO COMPLETION. THIS PEFiM1T MAY BE <br />CANCELLED BV TME CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. � . <br />I - - <br />