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--z,.-� <br /> � � � . <br /> m � x <br /> C9 H <br /> t" y5y � <br /> yYH <br /> � H � <br /> � H '� Date_— r�oi��wo��,r•a�mn. <br /> � H D�ap.DeoL• <br /> y ApplicaUon For <br /> x PUBLIC WORKS PERIVIIT PueTo�FeeFee S <br /> O y � Less nool fea Fa�o S <br /> � ['�iJ g Balance Oue S <br /> H` n Print or Type Only <br /> t"y� I <br /> H y SEPA <br /> �y y Plan Check No: B 37055 <br /> ��y A licat.Date: 06/16/92 Phone <br /> Owner pP,7ob Addre: 1330 AOCKEFELLER 2ND FLOOR <br /> �5 Owner: GENERAL HOSPITAL <br /> ``+ � Tenant: <br /> y y Propoeed Uee: MEDICAL OFFZCE BL�G phone <br /> y p y qpp�lcant pesc. of Work: <br /> T.I. – 1199SF <br /> Describe Proposed Work _ OFFICE SET�_�JOB SET_�� <br /> — APPRVD FOR PERMIT: DATE_/_I_ BY <br /> W <br /> Pro�ect Address lif known) � <br /> Attach four(4)coUies ol plans lor proposed wo�k- Draw lo scale and note the following as applicable: � <br /> • Property Lines • Centerline ot street ♦^ <br /> • Oulline and dimensions o1 all ezisling and • Indicate Nor�h V� <br /> _ proposed strucW res on the lot • Show any proposed groding changes <br /> • Eaistiny and proposed utilities • Show measurements M <br /> ' �� DO NOT WRITE BELOW THIS LINE W <br /> i o <br /> i ' PERMITCON�ITIONS <br /> �_ 1.All calls for inspection shall be made 24 hrs.ir advance-Fhone 259•8810. �\ <br /> 2.All work shall be pedormed in acr.ortldnce vnth ihis permit and current City ot Everelt Design and Construction ♦ <br /> ' ��' Standards and Specitications. <br /> ,I � 3.Call Location Underground Service 48 hra before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> I ' ' I�_ �" . .. . , . � ( ,� � O <br /> �`� , � ��o r c.: , ; : ��. . <br /> ��-J r <br /> � J � <br /> i �+�r��� '� . /. . <br /> C'. � �. <br /> O <br /> � ��_ a <br /> � <br /> I� �__ <br /> �' � ACKiJOIVLflDGEMENT OF CONDITIONS <br /> \ The undersi9netl cwner/apPli[an�hereby agrees to hold and aave h�rm� <br /> � -- less Ihe Ciry ol EvereU irom any and all claims lor damaqes, costs, <br /> expenses, or causes ot action thal may arise bewuse ot installation <br /> and maintenance of the improvemenl or olher ri9ht•ol�way use herelo � <br /> applied for antl lurther agrees lo remove same upon notice Imm �he <br /> Approved lor Conslrudion Date Cily and to�eplace public property tlamaged thereby. <br /> PINAL li�SPECTION ��1e D:ttc <br /> Approvetl a:ConstrucleA Signature ol Applicant <br /> W0�7K AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> �UBLICWORKSDFPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3700CetlarStreel BE DILIG[NTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everctt WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phar r:259-8910 pROJECT OVER�0 DAYS DURATION. <br />