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�. <br />TYFE OR PRINT ONi Y <br />Applicant <br />Application For <br />PUBLIC WORKS PERMIT <br />Describe Proposed Work _ <br />PROJECT ADDRESS (if known, <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everetl, WA 98201 259-8870 <br />Plan Check No: <br />Applicat.Date: <br />.7ob Address: <br />Owner: <br />Tenant: <br />Proposed Use: <br />Uesc. of Work: <br />T.I. <br />Date <br />Public Work� Permit # <br />Building Pertnit N <br />Public Works Fee $ <br />,�- Phone <br />B 52225 SEPA <br />07/09/96 <br />906 SE EVERETT MALL WAY <br />R/L WEST ENTERPRISES II Phane � <br />INTERWEST BP,NK <br />OFFICE <br />OFFICE SET JOB SET <br />APYROVED FOR PF;RMIT: DATE_/_�_ BY <br />Ariach four (4) copies ot pians for proposed work - Draw to scale and note the Iollowing if applicable: <br />•Property Lines 'Outline and dimensions ot all existing and proposed structures on the lot '6cisting and proposed utilities <br />•Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance -�hone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs, before you dig. TOLL FREE NUMBER 1-500-424-5555. <br />�>�IRUG 1^iORKS PFNM�' <br />NG� qEC]UIREA <br />=.'Y T �� <br />sATE .. _7.��'�.--^- <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />� <br />� <br />�♦^ <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicanl hereby agrees to hold and save harmless <br />the City of Everett from any and all claims tor damages, costs, expenses, or <br />causes oi action that may arise because ot installation and maintenance cf <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replaca pvblic property <br />damaged thereby. <br />II Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEf10N. THIS PERMIT MAY BE CANCEILED 9Y THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />�.: <br />y � <br />< <br />� <br />�.... <br />