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17 C7N <br />C N <br />?Hrn <br />tH>� <br />y <br />Date <br />Qx O H't <br />Application For <br />Cn <br />PUBLIC <br />WORKS PERMIT <br />Pori <br />H d <br />H � eo <br />Print or Type Only <br />ca• o <br />H <br />zy <br />z <br />coy <br />Owner <br />Plan Check No: <br />ru,r <br />B 35609 SEPA <br />H <br />Applicat.Date: <br />02/10/92 <br />n d ti <br />Job Address: <br />1402 SE EVERETT MALL WY <br />l t" <br />Owner: <br />MERVYN'S <br />b7 <br />HO CA <br />Applicant <br />Tenant: <br />Proposed Use: <br />H <br />Desc. of Work: <br />7,1 <br />TI <br />Describe Proposed Work <br />�r seeks. <br />sae a <br />Ark eta. <br />OFFICE SET JOB SET_ <br />APPROVED FOR PERMIT: DATE_/_/ <br />Project Address (if known) <br />BY <br />Public Work$ Permit e <br />Bldg. Debt. e <br />I Publ,C Work$ Fee S <br />Total Fee <br />Less APPl Fee Paid S <br />Balance Due S _ <br />Attach four 14) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />Phone <br />P.tione <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 hrs, before you dig. TOLL FREE NUMBER 1-800.424.5555. <br />for Construction <br />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 />UJ <br />r� <br />W <br />07 <br />n <br />z <br />k- <br />C y, <br />0 <br />®. <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 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 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 j <br />PROJECT OVER 90 DAYS DURATION. <br />t <br />