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Date 0/17/90 M. <br />Application For <br />PUBLIC WORKS <br />Print or Type Only <br />Preview Properties <br />T8B Ocnst. Inc. <br />IPpbLCWplke Pereel. -- <br />Bldg Dept I 90/2S607 <br />W <br />PERMIT ( Public p fee <br />711.1 Fee <br />Less Appl Fee Paid S <br />ealpnce Due S <br />R24 Everett <br />305 SE srorett Mall Way 7 <br />Address <br />2454 Occidental Ave S <br />Mailing Address <br />Seattle 90134 622-6212 <br />Lilly <br />Tenant Zboprovement <br />Describe Proposed Work <br />-.-- <br />Project Address lit known) <br />d note <br />Attach lour (4) copies of plans for proposed work • Draw to scale an0 Ce Iterline of street <br />able: <br />• Property Lines a Indicate North <br />a Outline and dimensions of all existing and a Show any proposed grading changes <br />proposed structures on the lot a Show measurements <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance. phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />5. <br />3, Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.555 <br />P1% ' fnJ <br />-, <br />Uale <br />Approved for Construction <br />Dale <br />FINAL INSPECTION <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />3200 Everett, <br />WA Street <br />Everelq WA 98201 <br />Phone: 259.8810 <br />W <br />r• <br />(n <br />0' <br />II <br />Z� <br />0 <br />N <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm' <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />Ciapplied <br />y land to replace lher publicgrees to propertyremove same upodamaged thereby.notice from the <br />Dale <br />Signature of Applicant MIT MUST BE <br />IWORK SO DAYS TOF DATE PERMIT ISESSUED ANDHORIZED BY THIS PR S HEREAFTER ISSTARTED HTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER go DAYS DURATION. _— <br />