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� ��. <br /> Date�2-2y�`1 PuELc WorMa�`vmil• <br /> Applicatlon For BICp Depl.� ��I /C1.�1�f1 <br /> PUBLIC WORKS PERMIT P°°��°W°�M,F�° <br /> Totnl Fee s <br /> Leaa�Oot Fee P�iE S, <br /> Print or Type Only e��.�=-o�e s <br /> PROVIDENCE HOSPITAL P.O. BOX 1067 EVERETT, WA 98206 (20G) ?58-7414 <br /> Owner MaiFng Address City Zip Phune <br /> NEWLAND CONSTRUCTION CO. , INC. P.O. BOX 958 EVERETT, WA S8?06 (206) 259-9191 <br /> Applicant Mailing Address City Zip Phone <br /> DescribeProposedWoik Remodel Central Services and Pharmacy <br /> W <br /> ProlectAddress�ilknown) 916 Pacific Avenue H <br /> Attech lour(4)copies ot plans for proposed work•Draw to scale and note the loliowing as applicable: � <br /> • Preperty Linea • Centerline of street �� <br /> • Outline and Aimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any prnposed grading changes <br /> • E�istinp and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspaction shetl be made 24 hra. in edvance•phone 259•8815. � <br /> 2. All work shall be pedormed in accordance with this permit and current City of Everett Deaign and Constroction <br /> Standarda and Specilicationa <br /> � S. Call Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•B00•424•5555. � <br /> l Y� ,Y ✓b(� '� liG��N 2S �,vsilr i/— /.ag-r.�-�._.�L. O <br /> `, � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanf hereby agrees to hold and save harm• <br /> — less the City of Everett from any and all Geims for damages. costs. <br /> ezpenses, or causee ol action that may arise because of installation <br /> and maintenance ol the improvement or other righho4way use hereto <br /> Approved tor Construction Date applied for and further agrees to remove same upon notice from the <br /> City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everet6 WA 98201 BE DILIGENTLY FURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEP.90 DAYS DURATION. <br />