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".v <br />Date <br />.. <br />Application For <br />PUBLIC <br />WORKS <br />PERMIT <br />Print or Type Only <br />Plan Check No: <br />B 38728 SEPA <br />Owner <br />Applicat.Date: <br />Job Ad <br />11/17/92 <br />6ERCHFEDERAL AVE <br />Ownet: <br />LUTH452 <br />CENTER <br />Tenant: <br />Proposed Use: <br />OFFICE SPACE <br />Applicant <br />Desc. of Work: <br />T.I. — 760SF <br />— DEMO WALLS, NEW WALLS, <br />ELECTRICAL <br />Describe Proposed Work — <br />OFFICE SET <br />JOB SET <br />APPROVED FOR PERMIT: <br />DATE_/__/_ BY. <br />qH <br />fi I" 1 <br />H�oo <br />rA <br />OH <br />O <br />SyH <br />t' H <br />ONH <br />�y�AO�y��yjjy�N <br />Hd� <br />ri <br />U <br />I -I <br />U <br />r 1 <br />U <br />easier <br />Public Works Perm - <br />Bldg .Debi . I - <br />Public Works Fee <br />Tolal Fee <br />Less APp: Fee Paid $ <br />Balance Due $ <br />Phone <br />Phone <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance -phone 259.8810. <br />2. All 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 his. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />":BLIC WORKS PERMIT <br />NOT REOUIRttJ <br />By— f <br />DATE 9' <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />CLPUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8810 <br />Date <br />W <br />H <br />mil <br />0 <br />z <br />0 <br />'H <br />Y / <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Tne undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public properiv damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 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 DURATION. <br />