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H0 ' � <br />M In <br />1-3 <br />AD PO <br />Q H <br />y r3 CAI <br />H H <br />FC C] <br />H0 <br />H '1 <br />(A H <br />OE <br />OHS <br />H00 <br />>HN <br />t" H H <br />O�H <br />0 UCn <br />�r <br />Z F.q Cod <br />130Cn <br />Date — <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or type Only <br />Plan Check No: B 35610 SEPA <br />Applicat.Date: 02/10/92 <br />Job Address: 1402 SE EVERETT MALL WY <br />Owner Owner: MERVYN'S <br />Tenant: <br />Proposed Use: RETAIL <br />Dodd. of Work: <br />REROOF <br />Applicant <br />OFFFICE SET JOB SET <br />Describe Proposed Work APPROVED FOR PERMIT: DATE_/_/_ BY <br />Project Address (if known) <br />Zip <br />Public WorYa Parma e <br />Bid'. Dept. s <br />PYEIIc Wdrka Fee $ <br />Total Fee <br />Lee. Apl. Fee Paid $ <br />Balance Due $ <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />a Property Lines • Centerline of street <br />o Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot N Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />Phone <br />PERMIT CONDITIONS <br />t 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 />w.a® <br />g� <br />Approved for Construction 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 />a:s <br />• <br />0 <br />w <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 <br />PROJECT OVER 90 DAYS DURATION. <br />IL <br />