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Date .. o�e�„H�a,..o,,.,�. <br /> � ' e�ea�o.o�• <br /> Applica�IG..�o� �� <br /> PUBLIC YIVORKS PERMIT °°°:o;;�:;"° : <br /> �.,..�o���.P.,a s <br /> om�uo�e 5 <br /> Print or Type Only <br /> ?lan Check No: 8 40130 SEPA <br /> Anplicat.Uate: 04 O1/93 <br /> Job Addresa: 76 1 kVERGREEN WY <br /> Owner: VY2ISC0 <br /> Owner Tenant: P::TCO ip Phone <br /> Proposed llse: RETAIL <br /> Desc. of Work: <br /> T.i. - 6,8175F <br /> APPlicant ip Phone <br /> OFFICE SET JOB SET <br /> Descrroe Proposed WOAc _ pppROVEU FOA PERMIT: DATE_/_/_ eY_ <br /> ___ '__. _ .-_ <br /> - W <br /> Prolec�Atltlress(il known) L <br /> i <br /> Attach lour�4)copies of plans I�!pwposed work-Draw�o scale and note�he tollowing as applicaEle: � <br /> • Proporty Lines •Lentedine ol streel /A <br /> •Outline antl tlimensions of all existing anE •Indicatc North V� <br /> �� proFosetl siruc�ures on Ine l01 •S�ow any pmposed grstlinq c�anges <br /> •Ezio�ing and�mposeG utilities •Show measuremenls � <br /> �O NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for InsOection shall ba matle 24 hrg,In acWance•phone 259•8810. ^ <br /> 2.Allwurkshallbepedormedinaccortlantevri��thispermi�anticurrentCl�yotEveretiDesignantlConsimction �� <br /> Standards antl Speci11ca0oni <br /> 3.CaIILacationUnderground5ervice48hrsbelareyoudig.TOLLFflEENUMBERI•800•4243555. � <br /> O <br /> PUBLIC WORKS PERMIT r <br /> NOT REOUIRED �j+� <br /> BV�B 4/� <br /> DATE `��= �ys' � O <br /> � <br /> ACNNOWLEOGEMENT OP CONDITIONS <br /> T�e untlersigned owneqapplicant hereby agrees ta hold and tave harm� <br /> - le;s t�e Cily of Everet� Irom any and all claims lor damaqes, cosls, <br /> e.penses, or causes of action ihat may arise 6ecause of inslallation <br /> ' antl maintenance af ihe improvement or other rig�t�o4way use herelo <br /> ApO�ovetl lor Cons�mclion Date appliod br and lutlher agrees lo remove same upon nolice Irom Ihe <br /> ,ity antl to�eplaca pu0lic property tlamaged thereby. <br /> FINAL WSPECTION Dalo <br /> AOpmveG as Conslmt�ed Signature ol Appliwnl Oale <br /> /Atl�i� PUBLIC WORKS DEPARTMENT WORK AUTHORIZED �V THIS PERMIT MUST BE STARTEO VJITHIN <br /> ffiOOCetlarSlreel 180 DAVS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> Everclt,WA 98201 BE DILIGENTIY PUPSUED TO COMPLETION.THIS PERfAIT MAY BE <br /> P�one:259�9810 CANCELLcD BY THE GTV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> k' <br />