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TYPE OR PRINT ONLY <br />Owner <br />Applirant <br />"ication For <br />PUBLIC V1►c�RKS PERMIT Date <br />Describe Proposed Work _ <br />PUBLIC WORKS DEPARTMENT Public Works Pertnit # <br />3200 Cedar Slreet <br />Everett, WA 98201 259-8870 Building Permit # <br />P:an Check No: B 50098 SEPA ksFee$ <br />Applicat.Date: 17./20/95 <br />Job Addreae: 96b5 EVERGREEN WAY <br />Owner: WANG YU-JEN <br />Tenant: DAVID EDWARDS phone <br />Propoeed Use: <br />Desc. of Work: <br />TI FOR DARTS/BAR <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_I_ <br />PROJECT ADDRESS (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale anc' �ote the following if appllcable: <br />•Property L1nes 'Outline and dimensions of all exlsting and proposed structures on the lot •Existing and proposed utilities <br />•Centerline ot street •Indicate North •Show any proposed grading changes •Show measurements <br />PERWIIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Cverett Design and <br />Coiistruction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />UfiLIC 'rvO�Kd PEANI' <br />p,p'( RF�UI!!ER <br />�Y��/ SS-- <br />,sRTE_- <br />Approved for ConsWction Dat� <br />FINAL INSPECTION Date <br />Approved as Constructed <br />W <br />� <br />�� <br />V♦ <br />V ♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplicant hereby agrees to hold and save hartnless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other ight-of-way use hereto applied for and fuAher agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />SignaWre of Applicant Date <br />COMPLETION. TV IIS P RN T MAY BE CANCEBIEDTBY THE CITYIUPON ANY oOPPACE OF WORK OSN THIS PHOJEC OVER 90 DAYS DUILRATIONLY PURSUED TO <br />