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, � <br /> DBie . n,mi,<wor,s v.�,mi. . ____—. _ II <br /> Applicstion For Ba9 0 � � I <br /> PUBLIC WORKS PERMIT Pu�l¢WO�kpGeo , _ <br /> ToiaiFeu <br /> LessApplGeeP:�� 5_ — � <br /> I <br /> ��'� Print or Type Only aa���. -c��_ s_. i <br /> [9 y � Plan Check No: B 39507 n �/ SEPA <br /> �� Applicat.Date: 03{ifrfB9- �J 93 <br /> T Hx!n Job Hddresa: 1203 SE EVT.'RETT MALL WAY � <br /> H >3 Owner �wner: EVERF.TT PACIFIC CORP Zip Phone � <br /> y z H Tenant: . <br /> K n Proposed Use: CHILDREN'S GYM <br /> y� Desc. of Work: <br /> � H O ' TENANT IMPROVESSENT -- <br /> '� Applicant Zip Phone <br /> [/�H <br /> �jz OFFICE SET JOB SET <br /> `" y d Describe Proposed Work APPROVED FOR PERI4IT: DPTE / / EY , <br /> H �O -- - - _. ,.. <br /> �y � — � <br /> z y� -- <br /> � 1- <br /> � f–i'-3 Project Address(if known) — — �'�' ��. <br /> � d� Attach lour(4i copies of plans lor p�opr,sed�vork-Draw to scale and note ihe following as apP�icable: �� ' <br /> � �r • properly Lines • Centedine N street � � �. <br /> � • Outline and dimensions ot ali exisling and � Indicate North <br /> • Show an r g <br /> 2 y(/� proposed slructures on ihe lot y p oposetl 9radin chare,es <br /> y Q� • Existing and proposed utilities • Show measurements � '', <br /> '����i��y—�!OTOW-m BELOW THIS LINE �`y, � <br /> � '�A I <br /> PERMIT CONDITIONS . <br /> 1.All calis tor inspection shall be made 24 hrs.in advance-phone 259•8810. � '� <br /> 2.All work shall be performed in accordance with this nermit and currenl City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � � <br /> 0�� �rp <br /> `� <br /> f �"j F.. <br /> «.� � � �'UBLIC WORKS PERMIT //S <br /> NOT REOUIRED �/�/ <br /> �� �°'' DY -�-fS%� O . <br /> �"� D AT E�______ <br /> p . G,�,� �. <br /> r` '"'� ACKNOWL[DGE�4ENTUFCONDIT.ONS <br /> ,:.``�, <br /> The unders9ned owner/applicant hereby agrees Io hold and save harm� <br /> less the City ot Everett irom any and all claims lor damages, costs, <br /> � expenses, or causes of action Ihat may arise because of installation <br /> and maintenance of Ihe irnprovement or olher rignt-ol-way us� hereto <br /> �! applied br and �urther agrees lo remove same upon notice from the <br /> Approved for Cons!ruclion �a�e City and to replace public property dama9ed thereby. <br /> FINALINSPECTION ��« <br /> �pproved as Constructed Signature of Applicant Dale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERh11T IS I�SUED AND TIiEREAFTER IS TO <br /> �"; 3200 Ceda:Stroet BE DILIGENTLY PURSUED TO COMPLE�ION,iHIS PERMIT �1AY BE <br /> r Evereti,bVF 96201 CANCELLED BY THE CIT"UPON AN1'S'OPPAGE OF INORK ON THIS <br /> Phonr_59��C10 i PROJECT OVER 90 DAYS DUFATION. <br />