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Date 1 9 9z <br />����cation For <br />PUBLI.'. 'aF�'c' <<�CS PERMIT <br />Print or Type Only <br />TENANT-Rollins Leasing Office <br />Public Wcrks Pe�mit s <br />ema oeo� • _ 92/35295 <br />Public Woiks Fee <br />Tolal Fre S <br />Less Appl. Feo PaIE S <br />Baianco Oue S <br />Bargreen 3200 Mcdongall Everett 98201 252-4192 <br />Owner Mailmg Address City Zip Phone <br />P.G.M. 2517 Fainier Everett 98201 252-9573 <br />Applicent MailingAddress Ciry Zip Phone <br />�' .. • �-. . � <br />Project Address (if known) <br />�r+•� <br />Attach four (4) copies of pians for proposed work - Dr�w to scaie and note the following as applicable: <br />� Property Lines <br />• Outline and dimensions oi all existing and <br />proposed structures on the lo! <br />• Existing and proposed utilitics <br />• Centerline ot streel <br />• Indicate North <br />� Show any proposedc�rading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calis lor inspection shall tie made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be periormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Catl Locatlon Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />���J � ��,�I ��J- /] <br />�iCLGGr/ �(�/'.2�'%�%n.Ct� iG L*��'�,C!✓..G(/LG-(y <br />6 <br />�>> <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Consirucled <br />�Ar�PUBLIC WORKS DEPARTMENT <br />3200 Cadar Street <br />Everetl, WA 98207 <br />Phone: 259�8810 <br />�� <br />�-/S-i/ '� <br />ACKNOWLEDGEAIENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />H <br />� <br />� <br />a <br />The undersigned owner/applicant herehy agrees to hold and save harm- <br />less tne City ol Everett from any and all claims for damages, costs. <br />expenses, or causes oi action that may arise because of installafion <br />and maintenance of the improvement or other righl-ohway use hereto <br />applied for and further agrees to remove same upon notice from the <br />City anC to replace public prop��rty damaged thereby. <br />Signature of Applicant Oate <br />WORK AUTHORIZED 8Y THIS PEFMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERPAIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT A�'AY 6F <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK CN THIS <br />PROJECT OVEF 90 DAYS DURATION. <br />