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�ate PuOL�Workf Permll• <br /> Application For eieq.Deu�.• <br /> PUBLIC WORKS PERMIT P�e���W��h,F�e <br /> Totai Fee S_ <br /> L<ss ApD�Fee PaiO S <br /> Print or Type Only Plan Check No: B 46205 SEPA eaio��eo�� S_. <br /> Applicat.Date: 11/14/94 - <br /> Job Addrs: 1330 ROCKEFELLER <br /> Owner: PROVIDENCE GENERAL MED <br /> Tenant: EVERETT CLINIC OB <br /> Propoaed Dee: MEDICAL OFFICE <br /> Owner Deac, of Work: 2�p Phone <br /> T.I. <br /> OFFICE SET JOH SET <br /> Applicant Zip Phone <br /> APPRVD FOR PERMIT: DATE_/_/_ BY <br /> Describe Proposed Work . <br /> - W <br /> Project Address(if know�) � <br /> Attach four(4)copies of plans for proposed work- Drew to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> � Outline and dimensions ol ail existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> t.All calls tor inspectbn shall be made 24 hrs,in advance-phone 259•881 O. � <br /> 2.All work shatl be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specificatians. <br /> 3.Call Location Underground Service 48 hrs,before you dig.TOLL FREE NUMBER 1•800•424-55�5. � <br /> O <br /> ?UBLIC WORI<S ppp,M�T � <br /> ti0� REpUIRE� � <br /> �Y S' <br /> uATE � s ,��' O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold aid save harm� <br /> less the City of Everett trom any antl all claims for da nages, costs. <br /> ezpenses. or causes of action Ihat may arise because �f instaile;ion <br /> and maintenance of the improvement or other right-of-way use hereto <br /> applied for and further agrees to remove same upon nUice from ihe <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Dale <br /> PUBL�C WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTE� WITHIN <br /> 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREA"rTER IS TO <br /> Everett,WA 98201 BE �ILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259-8810 I CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 30 DAYS DURATION. <br />