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i <br /> D3lB r�oi�c wo,�.ve�m��� <br /> ApPlicatlon For e'ao oeo�• <br /> PUBLIC WORKS PERMIT °°��Kw°,.,�•. <br /> ,o�.�,.. s <br /> Lo��eo��eeva�a S <br /> PrintorTypeOnly e.n��.o�. s <br /> Pler Check No: C 42225 SEPA <br /> Applicat.�ate: 10/O1/93 <br /> Job Addre: 1321 COLBY AVE <br /> Owner: EVERETT GENERAL HOSPITAL <br /> Tenent: BEHAVIOAAL HEALTH DEPT <br /> Owner Propo9ed Uee: MEDICAL Z�P P�ano <br /> Deac. of wnrk: � <br /> OFFICE FAf,ILITIES <br /> Applicanl pFFICE SET JOB SET Z'p Phone <br /> APPRVD FOR PERHIT: UATE_/_/_ BY � <br /> Oescribe Proposed Work . <br /> W <br /> Pm�ecl AECress(il known� � <br /> Attach low(4)topios ol plans lor pwposed wo�k�Draw to scale antl nole Ihe lollowing as applicable' � <br /> • Pr,perry Lines •Contetline ol sireel /A <br /> •Outline an0 tlimensions ol ell eHisling antl •Indi�ate Nnrlh V� <br /> p�opoSeC Slmtlures On I�0101 •Show any proposeE gratling t�anges <br /> •Eaisting anC pmposed ulilities •Show measuremenls � <br /> DO NOT WRITE BElO\Y TN:S LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor inspeclion SAall be mado 24 hrs.in aAvanta•�.�one 259•88�0. � <br /> '_.All work shall be pedormetl in accoidanw with t�ls permit and currenl City ol Everett 0?sipn antl Construclion <br /> SlanEards end Specilications. <br /> 3.CalllocatiOnUn�Crgmuntl5ervice48hr5.beloreyoutlig.TOLLFREENUMBERI•$00•424•5555. � <br /> O <br /> .'UBLIC WORNS PERMIT � <br /> NOT RCOUIRED //� <br /> OY ' L� \// <br /> OATE!L' Y �� O . <br /> a <br /> ACKNOwLEOGEMENT OF CONDITIONS <br /> Tho unGer5i9neE owner/applicant hcreby aBrees lo holtl anC save�arm� <br /> les. I�e City ol Everetl irem any ana all claims br damages, cosls. <br /> e.Censes, or causes ol attion inat may arise beca^se ol inslallalion <br /> antl maiNenance ol Ihe im0�ovemenl ar other righLul�way use hereto <br /> applied lor and Iuri�er aB�eos to remove 5ame upo� nolice Irom the <br /> ApProv¢tl br Conslrutiion Dale ���y an0 b w0lace puGLc pmpetly damageE I�ereEy. <br /> FINAL INSPECTION Daie <br /> Ppproved as ConslmcteC Signature ol Appli<ant Oate <br /> ��� PUb�IC WORNS OEPARTMENT \YORK AUTMORIZED BY TMIS PERM�T MUST BE STARTED WITHIN <br /> J200CeDarnLe-1 180 DAYS OF DATE PERh11T IS ISSUEO AND THEREAFTER IS TO <br /> Eveietl.WF 9820� BE DIUGENTLV PURSUED TO COMPLETION.THiS PERMIT MAY BE <br /> P�one.259�eB10 CANCELLE�DY TNL CRV UPON ANV STOPPAGE OF WORK ON TMIS <br /> PROJECT OVEP 90 DAVS DURATION <br />