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1 <br /> Pu0i2 Worws Pe�mp• <br /> Dale � eiac.oeo��• <br /> Appliwtion ror _ <br /> PUBLIC WORKS PERMIT ouEi¢Wo�M�Fee <br /> Tolel Fee S- <br /> Less PDC�.iee Pa�O S <br /> B�i��ce0ue S <br /> H Print or Type Only <br /> ��q " !'lan CllecK No: B 3U2.i8 StiPH <br /> >y Applicat.Date: 10/O1/92 <br /> p�f x J�b Addrn: 3020 RUCKER AVE phone <br /> C y y Owner: SNOHOMISH COUNTY HEA':.TH Z'P . <br /> y� Owner Tenant: 2ND FLOOK RH 206 <br /> H � Propoaed Uee: HEALTH CLINZC <br /> �esc. of Work: phone <br /> K f~] TENANT IMPROVEMENT 2024 SP Zip <br /> H�7 APPlicant <br /> �y H OFFZCE SET JOB SET <br /> H� Descrihe Proposed W APPRVD FOR PERMIT: DATE BY <br /> p —�—�_ <br /> �HC <br /> ��g W <br /> �j]V �] <br /> z�� E- <br /> >H Project Address(il known) <br /> C" � <br /> ~y Altach lour(4)copies ol plans lor proposed work-Draw to scale and note Ihe following as app�icable: <br /> l7 V� • Centerline ol slreet � <br /> ��y • Proper�y Lines <br /> .� Outline and dimensions ol all existing antl • Indicate North <br /> �t+ proposed structures on Ihe lol • Show any proposed grading chanqes <br /> t4 • Exisling and proposed utilities • Show mexsuremenis /� <br /> y�w O <br /> DO NOT WPITE BELOW THIS LINE <br /> � � PERMI7CONDITIONS � <br /> 1.All calls lor Inspection shall be maae 24 hrs.in advance-phone 259•8810. <br /> � 2.All work shall be pedormed in accordance with this permit and current City ol Everelt Design and Constmction <br /> � Standards and Specifications. <br /> � �� . 3.Cail Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �'i��,'_r` L�-.�.L'� /_ . ,,,�i� �? ��r "���v.� .:i � � <br /> „ _�> � � <br /> � ,_� /��_,� , <br /> � �� /� <br /> V♦ <br /> � O <br /> ' __' a <br /> ��=i <br /> AGKNOWLEDGEMENT OF CONDITIONS <br /> �,_ The untlersi9ned oaneUapp�kanl hereby afl�ees to hold and save harm- <br /> ' less the City ol Everell Irom any and all claims lor tlamages, costs, <br /> e.penses. or causes oi action that may arise because ol installation <br /> and mainlenance ol Ihe impwvement or other righ4ol-way use hereto <br /> applied lor and tur;her agrees Ic remove same upon notice Irom the <br /> Approved lor Construction Dale Ciry and to replace pu6lic property damaged Ihereby. <br /> FINAL INSPECTION Date Dale <br /> ApProved as Construcled SignaWre of Applicant <br /> G�, WORK AUTI10RI2ED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> �ar�y� PUBLIC WORKS DEPARTMENT 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS .TO <br /> ��1, 3200 Cedar Street BE DILIGENTLY PURSUEO TO COMPLETION.THIS PERMIT MAY BE <br /> f�E�T Everelt,WA 98201 CANCEI.LED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phona 25:'�8810 PROJEJT OVER 90 DAYS DURATION. <br />