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08te 9-24-92 Puei�c WOM1e Perme• / �' B � <br /> Appliwtion For eieq neo�.•��130 <br /> PUBLIC WORKS PERMIT P°°:oWF«°°� . <br /> Less Aoo�.Fee PeiE f <br /> Baientt Due s��S� <br /> Print or Type Only � � _ � 5 Op,2 - 32Z�/D//B3/ <br /> TO POSTING �' <br /> Providence Hoepital 916 Pacific Ave Everett WA 98206 258-7853 <br /> Owner . MaiNng Address Ciry Zip Phone <br /> N.G. Jacobson 6 Aesoc 520 Pike St Seattle WA 98101 624-7863 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed work �ree parking decks above existing 3-level parking garage <br /> W <br /> Project Address�it known) 916 Pacific Ave � <br /> Attach tour(4)copies ol plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> propoaed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.A��cane tor�nspect�on sna��be made 2a hrs.in edvance•pnone 25�-8810. � <br /> 2.All work ahall be peAormed in eccordance with this permit end current CiQy ot Everett Design and Conntruction <br /> Stendarde and Specifications. <br /> 3.Call Locetion Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1-800-4'3455�S�S. � <br /> !� �tv2y �2u'cr-"7`�.co�.i /rD � di>zv �F/i ,'�/4�„/ O <br /> O �� <br /> ��� �,v io- ad-92 6� � ��.�f <br /> f,.u�-c� W�z/n. `�� �Dr'y ra�'�4�'� � <br /> l. 0 � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees�o hold and save hprm� <br /> less ihe City of Everett from any and al! claims for damages, costs. <br /> / / ///111 expenses, or causes of action �ha� iday a(se because of inslallation <br /> /7�� /(_J� /0 Z � and maintenance of the improvement or other ric�hbof-way use hereto <br /> ��/1 �l applied tor and further agrees to remove same upon �notice irom �he <br /> Approved for Cons�rucLion �a�e City and to replace public property damaged thereby. <br /> ���— r-y-sr r �2-21—�i Z <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signa re licant Date <br /> � PUBIIC WORKS DEPARTMENT K AUTHORIZED �Y THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-BBtO CANCELLED BY 7HE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. . <br />