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Pubiic Works Permlt s <br /> DateS/3/�]- 9iaq DeOt.+ 9i i2�na� <br /> Application For <br /> PUBLIC WORKS PERMIT PJOToaIFee�ee $ <br /> Less Appl Fee PaiO w5 <br /> ealance�ue 5 <br /> Print or Type Only <br /> Volunteers of America 2802 Broadwa Everett 98201 259-3191 <br /> Cit ZiP Phone <br /> Owner MaiVing Address 1' <br /> Dykeman Architects " Z;P Phone <br /> – Mailing Address City <br /> ppplicanl , <br /> Tenant improvement <br /> Describe Proposed Work <br /> W <br /> 2801 LomUard � <br /> Prolect Address(il known) —� <br /> A�tach four(4) copies of ptans for proposed work- Draw lc scale and note the tollowing as applicable: � <br /> • Property Lines • Centerline of street <br /> • Indicate North <br /> • Oulline and dimensions of all existirig and � Show any proposed grzding changes <br /> proposed structures on the lot • Show measurements � <br /> • Existing and proposed u�ilities <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1,All calls for inspection shall 6e made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be performed in accordance wilh tnis permit and current City of Everett Design and Const:uction <br /> Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•55 • <br /> /�v���i Gu ' � <br /> 011�y f'�[:rL7n.c^t'- /�/c„I� �C�f�Cc,c�.:�✓ <br /> l L/ ° I- <br /> 4�-3 r � N <br /> Q <br /> �. <br /> ACKNOWL[DGEMENT OF COPiDITIONS <br /> The undersigned owner/applicant hereby agtees lo hold anA save harm� <br /> ------- less ihe City ol Everelt from any and all claims for damages, costs. <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance uf lhe improvemen! or other ri9M-ohway use herelo <br /> applied for and further a�rees to remove same upon notice Irom ihe <br /> Approved for Construction <br /> Date City and to replace public property damaged Ihereby. <br /> Date Date <br /> FINAL INSPECTION Signa�ure of Applicant <br /> Approved as Constructed WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLICWORF:SDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> ' 3200CedarSireet BE DILIGENTLY PURSUED 70 COMPLETION. THIS PERMIT MAY BE <br /> Everell,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON T�fIS <br /> ��� Phone:259-BB10 PROJECT OVER 90 DAYS DURATION. <br />