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Date _ <br />Application Fo� <br />PUB�.IC 1PVORKS PERMIT <br />Print or iype Only <br />Owner <br />Plan Check No: B� 47.597 SEPA <br />Applicat.Date: 08!n9�93 <br />Job Addre=s: 19C?. SE EVERETT MALL WAY R16 <br />Owner: 7IT8NIC ASSOC <br />Tenant: !>ROSSER'S PIANO <br />Proposed Use: itETAZL <br />Desc. of 47ork: <br />TENANT IIAPROVEMEN'i <br />Applicant oFFICE SET <br />Describe Proposed Work <br />Projecl Address (if known) <br />SET <br />APPROVED FOR PERMIT: DATE / / <br />BY <br />Pud�,C l0ork5 Pcrmil 1 <br />B�aP Dept. s <br />PuClic woMs Fee <br />To�al Fee 5 — <br />Less AFaI. Fee Paitl 5_ <br />Balancc D�e $ _ <br />ZiP Phone <br />Zip <br />Attach four (4) cepies of plans fur proposed �vnrk - Draw to scale and note ihe following as applicaC6>: <br />O Property Lines <br />• Outline znd dimensions of all existing and <br />proposed s�ructures on �he lot <br />• Exi,ting and proposed utilities <br />• Centerline of sireet <br />o Indicale Norih <br />� Show any proposed gradino �;r - r„�s <br />• Show niezsuremenis <br />i <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All calls f�r inspeclion ;hail be made 24 hrs. in advnnr,e - phone 259•8810. <br />2. All work shall be pedormed in accordanoe with this Germit and current City of Eve:ett Design and Consiruction <br />Standards and Specifications. <br />3. Call Locatien Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424-5555. <br />Approved for ConsGcction <br />PUQ��C <br />N�T w�R{cS p . <br />By REqU/qEp �oT <br />�qTE'�� : � <br />� <br />���� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersic�ned owner/applicant hcreby agrees to hold and save harm- <br />— less the City ol Everett irom any and all claims for damages, costs, <br />I expenses, or causes of action that may arise Secause of installation <br />ard maintenance of lhe improvement or other right�ohway use here,o <br />applied lor and turther ag:ees to remove same upon notice from the <br />Date Ciry and to repl3ce public property damaged thereby. <br />FIMAL INSPECTION Date <br />Approved as Conshucted <br />�. PUBLIi, WORKS �FPARTMENT <br />r 3200 Cedar 5treet <br />Everctt, WA 98201 <br />Phanc 255�3810 <br />SignaWre of Applica�.t Date <br />WORK AUTHORI'LED EY THIS PERMII' MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUcD AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMFLETION. THIS PERMIT MAY BF <br />CANCELLE� SY THE CITY UPON l�IJY STOPPAGE Or WORK ON TNIS <br />PROJECT OVfiR 90 G�YS DUFP.TION. <br />