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� <br />� <br />TYPE OR PRINT ONLY <br />Owner <br />Appl�canl <br />�..����o� Fo� <br />PUBLIC V1�JRKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Streel <br />Everetl, WA 98201 259-8810 <br />Describe Proposed Work _ <br />PRWECT ADDRESS (if known) <br />Plan Check No: <br />Applicat.Date: <br />Job Addreee: <br />owner: <br />Tenant: <br />Propoeed Uee: <br />DADDITIONWOFkAN <br />DOCK <br />B 55154 <br />OSb/19 97 <br />JUDD &$BLACK � <br />RETAIL <br />—. <br />Uate _ . — <br />Public Works Permit N <br />Building Permil p _ <br />Public Works Fee $ _ <br />SEPA <br />Phone <br />OPEN SHED ROOF OVER LOADING Phone <br />OFFICE SET JOH SST <br />APPAOVED FOR PERMIT: DATS_/_I_ BY <br />ptlseh Iour (4) coples of plene fw proposed work - Oraw to scele and note the following M applicable: <br />•property Linea '0� itline end dlmensions of all existing and proposed structures on the lot •ExisNng and p�oposed utilitles <br />�Centerline ot atroet •Indicate NoAh 5how any proposed greding chanqes •Show measurements <br />PERMIT CONDITIONS: <br />1. All cails for inspection shail be made 24 hours in advance - phone 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 NUlNBER 1-800-424-5555. <br />�:,IpL1U w0��(S PFIW�. <br />'oOT RGfiYil�G�` <br />=r..�'B _ _. <br />tiarz S Z� 97 <br />.._ �._... <br />Approvad tor Constructlon D�te <br />FINAL INSPECTION Date <br />Approved as Constructed <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to Fwld and save hertnless <br />the Ciry oi Everett from any and ali claims tw damages, wsts, expenses, or <br />causes of action that may arise because of instailation and meintenence ol <br />the improvemenl or other right-ot-way use hereto applied tor end funher agrees <br />lo remove same upon notice 1rom the City and to replace public proparty <br />damaged lhereby. <br />Signature of Applicant Date <br />OMPL ON.RTH SD ERMIT MAY BE CMICELLEDTBY THE CITYIUPON ANY S�TOPPAGE OF WORK ON THIS PROJEC OVER 90 DA S DULRATIONLY PURSUED TO <br />