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Date <br />Appliutlon For <br />PUBLIC WORKS PERMIT <br />Print of Typ@ Unly ApplicatcDate: 06%25%93 SEPA <br />Job Addre: 341Y HbYES ST <br />Owner: PEREIRA JOE <br />Tenant: <br />Owner Desc�ofdWork� �FFICE/WAREH��USE <br />TENANT IMPROVEHENT <br />ApplMsnt <br />DescNbe Proposed Work <br />Project Addrea (If known) <br />OFFICE SET JOB SET <br />APPRVD FOR PERF:IT: DATE_/_/_ BY <br />� <br />h0lic Wo�k� Pbmn • <br />eaa o�oe � _ <br />hDuc WorW Fw <br />Tobl fN = <br />L�O 11ppL FN P�iO f <br />8�4nt� Du� f <br />ZIP Phone <br />Attaeh four (4j copie� of pl�ns for proposed work • Draw to scale and note the following as applicatle: <br />• Property Linea • Centedine ot stroet <br />• Outline and dimensions of all existinp and • Indicete North <br />proposeC structurca on tha lot • • Show any proposed prading chenqea <br />• Eziating end propoaed utlliHes • Show measurements <br />Phone <br />PERM�T CONDITION3 <br />1. All dlls for inspectbn �hsll be made 24 hrs. in advence • phone 259�8810. <br />2. All work shall bs peAormed in nccordence wIM thln permit and current Ciry of Everett Desipn and Conetr�ction <br />Stend�Ms �nd 3pecificatlons <br />3. GII l.oc�tbn Underpround Senice 48 hn. beforo you diy. TOLL FREE NUMBER 1-800�4245555. <br />: L�3LI� 11�CSRKS P <br />NOT . REpUIREpRMIT <br />i' Y �' <br />�1ATE 7�' � � <br />Approvetl for Conatruction Date <br />FINAL INSPECTION Dete <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everott, WA 98201 <br />Phone:259�8870 <br />ACKNOWIEDGEMENT OF CONDITIONS <br />W <br />H <br />G� <br />The undersigned owner/epplicant hereby aflrees to hold end eeve herm- <br />less the City of Everett irom any and all claima for Aamapea, costs, <br />expenses, or causes of action thet ney er(se beceuse ol inslellatfon <br />end maintenence of the Improvement or olhei rlpht•ot•way use hereto <br />epplfed for end further aprees to temove aame upon notice Irom the <br />City and to replace public proparty damaped thereby. <br />Signature ol Applicent Dete <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1P0 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 Th11S <br />PROJECT OVER 90 DAYS DURATION. <br />