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�� <br /> �� � � <br /> A� x <br /> G H <br /> 9H � <br /> r <br /> H '.� <br /> fG C� <br /> O x O Dale 6 26 90 ��_�.� �;..:.,,��.,_.,. __ . _... _._ . <br /> A1 H ';1 m�.r� o,�m . 0/24987 <br /> y �.,.� Applicution For � <br /> � R PUBLIC WORKS PERMIT " `""w°",�°� <br /> x r�„�F�� s - <br /> �-] d lras.+no�Fce va�e 5 <br /> OH <br /> H �, g o.,�:������� s <br /> �„ n Prinl or Type Only <br /> Zyy�r H y General Hospital Medical Center 1321 Colby Ave. EVr_,-ett 98201 258-6517 <br /> g y �,,,� Owner Mailing Adtlress City Zip Pho��e <br /> C]C57 t/� <br /> � `" � Pu �,t Sound VasculdLLah1 <br /> z H Cn APF�ican� Maiiin9 Address City Lp Phonc <br /> HOCn <br /> C]escribeProposedWork T T — �d�ra1 far�liYv <br /> W <br /> proiectAddressl��known� 1330 Rockefeller - 3rd fl. _ ` I <br /> Attach lour(41 copies of plans tor proposed work- Draw to scale and note the followino as appl�.cable � <br /> • Property Lines • CeMerline �f streel �■w■ <br /> • Ouiline 2nd dimensions ot all existin�ind • Indicate P:orih �/ I <br /> proposed structures on the lot • Show an�propos�d c�rading chan�es <br /> • Existing antl prOposed uiildies • Sl�ow maasuremeni_ M <br /> / . W I <br /> � DO NOT.VRITE BELOW THIS UNE O 'i <br /> I �_,. <br /> PERMIT CONDiTIONS I <br /> �I � t.All calls for inspection shall be matle 24 hrs.in ativance-phone 259-881 Q � I <br /> �� 2,All work shall be pedormed in accordance with this permit and current City of Eeerett Desi9n antl Construction <br /> � � Standards and Specifications. <br /> '� 3.Call Location Underground Service 48 hrs.before you Aig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � �+ �—,►� /��,.:Y<� �����-��' i�� .', : �" ,Y r .(. , � . . <br /> �� <br /> . ,��� ;;�' , ,— .; , ♦�' <br /> 1 '� , -� % -. � ^ <br /> . ,_ V♦ ' <br /> '�1r� I <br /> O I <br /> 1�1_j a <br /> I 1� �CKNOWL[DG[MENi Of'CUNDITIONS <br /> \� __- —_ .. _.___ __._ _—__ <br /> Thr unAersiy)iwd owner/appGCant hcreby agrees to hold in�1 savr hann- <br /> � Iess Ihe City of [verelt from any and all claims tor damages-, cosis. <br /> Iexpenses, or causes ol aclion ihat may anse Uecause of installatiun <br /> and mainlenance of thc unprovemenl or olher ri9ht-of�way use herelo <br /> _____ _— — � applied for and luriher agrees to �emove same � on nolice Irom the <br /> Apprm�ed loi Constiurbon ���'�'�' Cdy and lo replace pubGc preperty damayetl IhereUy. <br /> FINAL INSPECTION Date <br /> Approved as ConSiructed .`,i9nature ol Applicant Date <br /> WORK �UTHORIZED f3Y THIS PERMIT MUST BE STARTED WITHIN <br /> evrrrtl PUBUCWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUCD AND THERE�FTEFi IS TC� <br /> � 3200CedarSlreet B[ DILIGENTLV PUF�SUED 70 COMPLLTION. THIS PEH69T P,1nv f3L <br /> Everelt.WA 9P201 CANCFLLED 6Y TH[CITV UPON ANY S10"PA,I_n��Y01.1i U1J 1 fUti <br /> Phonn.?59�OR70 P170J[C1 OA LR!l0 DAV� Ul,HA710�J <br />