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F <br />� y co <br />K CD <br />H0 <br />Ow0 <br />V1 H <br />O� <br />r3 t7 <br />OH <br />zH <br />y <br />O y <br />H <br />O l7 !A <br />zHcn <br />I-3 0 of <br />Date <br />Application For <br />PUBLIC 'NORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />Project Address (if known) <br />Plan Check No: <br />Applicat.Date: <br />Job Address: <br />owner: <br />Tenant: <br />Proposed Use: <br />Desc. of Work: <br />T.I. <br />OFFICE SET <br />B 33/6379 SEPA <br />114b2E 6S2EVERETT MALL WY #106A <br />TITANIC ASSOC <br />DAN JESKE GREETINGS <br />RETAIL <br />JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />Public Works Permit <br />slog. Dept e <br />Public Works Fee <br />Total Fee <br />Lose Abot Fee Palo $ <br />Balance Due $ <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 />Phone <br />1 ' PERMIT CONDITIONS V V <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. <br />[ Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />►�� �u wad /VO-7l` <[? <br />Approved for Constructior Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett WA 98201 <br />Phone: 259-8810 <br />i <br />cM <br />W <br />O <br />n <br />Z <br />O <br />am <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The 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 instellation <br />and maintenance of the improvement or other right-of-way use hareto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property 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 />