Laserfiche WebLink
Date PuOi�c Wo��s Peimd• <br /> B�ag Deo�.• - <br /> Application For <br /> �PUBLIC WORKS PERMIT P �To�c�eFea S - <br /> Le5s4p0� f?ePa�p 5 <br /> Plan Check No: B 44440 SEPA ea�.��eo�� 5 <br /> Print or Type Only ApPlicat.Date: OS/19/94 <br /> Job Addreee: 3070 RUCKER AVE <br /> Owner: SNOHOMISH HEALTH DISTRICT <br /> TPnant: <br /> Propoeed Uee: CLINIC <br /> Owner Deec. of Work: Lr. Pnn�e <br /> INTERIOR TENANT I!lPROVEMENT <br /> qpplicant <br /> OFFICE SET JOB SET -��p ��� Phona <br /> APPROVED FOR PERMIT: DATE_/_/_ BY <br /> Desc�ibe Proposed Wo�k - — <br /> --- - - ---------- W <br /> Project Adtlress Id known' ._- - ----- -- � — � <br /> Atlach four I4) eoPies M Plan;lo� UroPosed wu�e � Dra.•: ta ,c.ii...�co nrte raa b4uwiny as apphcaC�e. � <br /> • P!oPe�ty Lines • Cr.nterlinr. nf Street � <br /> • Outlme and dimensions of all�si5tmg anA • I�eiCal? Nrrih <br /> proposea structures on Ihe�o� • Snow any r,reaosen gradmo chanaes <br /> • Ez:sting and proposed utihGes • Show measuremems � <br /> DO NOT WRIIE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work sha�l be peAormed i:-,accordance with this permit and current City of Everetl Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Undergrouna Service 48 hrs.before you d?g.TOLL FREE NUMBFR 1•B00•424•5555. � <br /> � <br /> PUBLIC WORKS PERMI7 � <br /> NOT REOUIRED � <br /> BY <br /> OATE Zv � O <br /> a <br /> ACKNOWLE.^,GEMENT OF CONDITIONS <br /> ihe �.i^dFrsianetl ownP.r-apphcart he�2by agrees to hold and Sace harm- <br /> --'- �--'---i iess ;he C�ty c� Everett Irom any and ali Caims lor tlamages. costs <br /> ; c.penses or Cau5e5 of aCiion �h2t may 0ri5? beCause 01 �n5iallg�ion <br /> � � -�- and ma�ntena�ce n! the impro�eme�t or other ngh4-o��way use hereto <br /> I acp���rd �cr and lurtner aqrees to rPmove S�mO upo� nOtiGO ��om Ihe <br /> Appwved lor Consiruclion ���" � C�;y ai:d to�eplace pubhc prooerty Camaged thereby. <br /> i <br /> I <br /> FINAL INSPECTION � Date Da�e <br /> Approved as Constructed Signature ul Applicant <br /> WORK AUTHOFIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> �A�� PUBLICWORKSDEPARTMENT 180 DAVS OF DATE PERMIT IS ISSUED ANO THEREAFT�R IS TO <br /> 3200CedarSireel BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON i HIS <br /> Phone:259-8810 pROJECT OVER 90 DAVS DURATION. <br />