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�r� <br />ay <br />C�H <br />9 H cn <br />H a� <br />HZH <br />K � <br />H� <br />'�+9 H "�+J <br />V1 H <br />H C <br />�O� <br />HO <br />O H <br />��g <br />� V n <br />H <br />Z H <br />rHH <br />gy <br />H <br />C� C1 V1 <br />��� <br />HO� <br />Dale Z��/9^ <br />� <br />, ApPlication For <br />, PUBLIC WORKS PERMIT <br />,� <br />Priiit or Type Only <br />Adtlress <br />2t:nant�i - Ro.ie�'s Pizzn n?:air Loft <br />Applicant Mailing Adtlress <br />�� I <br />2ip <br />publ¢ Wo�Fa Pormil • �'�'' ��r I <br />Biao�Depi.�3'`SOS L ASC�I!'i <br />PublicWorkaFce 5 <br />Ta1N Feo <br />Lav Appl Fen Pdi� S <br />� ,Cau <br />a.,i.,,,�an��. S <br />. ._ .- _ . �.. .i <br />Phone <br />Describe Pwposed Woik T°nant impmvement (81vi�iei axiatix�q building fnto 2 seoarate busineaeeP) �� <br />il ,�, �-.,y �:, 1..� �,.., fi:r /,i..,cY' i G '� _ � <br />i <br />'i �,l�, �� . !_�•��:✓i�p.. ��� <br />Project Address Iif knowm 3710 Muk11te0 II1vA. �'1 G S2 <br />Atlach lour (4) �oPies ol psns lor pro0osed wo�k • D�aw to scale and note the following as appllcahle: <br />• Froperty Lines • Centerlme of streel <br />• C utline and drnensions ol all existing and • Indicate North <br />p'opoCed struGtures on �he IOI • Show any p�oposed gradirg chan9es <br />• E ci5tin9 and pr�posed ut��i�ies • Show measurements <br />PE H M IT CON DITIO V S <br />1. A I calls for inspeCion shall be made 2d hrs. in advanco - phone 259•8810. <br />2. A I work shall be pedormed in accordance with this permit ano curreM Ciry of Everett Design and Construction <br />Standards and Sperilications. <br />3. Call Loca�ion UnderQround Service 48 hrs. bobre you dig. TOLL FREE NUMBER 1•800•424•5555. <br />j. �, _ i . - , / <br />_ ,' <br />I <br />'�): � Gj---•/-4Y ..'�.c�/:_ <br />�� ApproveC lor Consiruction � Dale <br />' I <br />'�. FINAL IN3PECTION Datc <br />� Approved as Conslructed <br />�I � PUBLIC WORKS DEPARTMENT <br />I 3200 Cedar Street <br />T� Everetl, WA 98201 <br />I Phone:259�8810 <br />! .__— _'_—__'---__._—____...___. _. _._..__... _ <br />% <br />��, ,., , ,'r�, �� _, V <br />Z� <br />� <br />O� <br />,�A ', <br />Vd� <br />�� <br />ai <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi9netl owneUapplicant hereUy a�rees lo hold. nd save harm� <br />less Ihe Cily ol Everett irom any and all claims lor damages. costs, <br />eapenses, or causes o� action Ihat may arise because o� installation <br />and maintenance of Ihe Improvement or other ri9h4of�wal' use hereto <br />applied tor and Iwther agrees lo remove same upon notice iwm ihe <br />City and to replace public pmperty daina�jed thereby. <br />i <: _� = �-�:-' � � <br />,,� :.: _ , . / ��`%d <br />S�yn�ie of Applicanl Date <br />� WOfiK AUTHORIZED BY THIS PERMIT MUST BE STAFiTED WITIiIN <br />tE0 D�YS 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 THIS <br />PROJECT OVER 90 GAYS DURATION. <br />