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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: B 44439 SEPA <br />Applicat.Date: 05/19/94 <br />Job Address: 2802 COLBY AVE <br />Owner: PORT GARDNER PARTNERS <br />Owner Tenant: GOLDS GYM ZIP <br />Proposed Use: GYM <br />Deso. of Work: <br />TENANT IMPROVEMENT <br />Applicant Zip <br />OFFICE SET JOB SET <br />Describe Proposed W. APPROVED FOR PERMIT: DATE_/_/_ BY_____ <br />Project Address lit known! <br />Attach four (4) copies of plans for proposed work - Drav: to seal? and ncIe the !oI lowing as aopIicabb <br />Public Works Permit e <br />Bing Dept <br />Publ, Works Fee <br />Total Fee S <br />Less coot Fee P.,o $ <br />Balance Due a <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any cr000sed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />Phone <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 />3. Call Location Underground Service 48 him before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />PUBLIC WORKS PERMIT <br />NOT REOUIREp <br />9Y 1�' <br />uATE <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />WORKS DEPARTMENT <br />CLPUBLIC <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />I <br />0 <br />z <br />0 <br />f <br />0 <br />a <br />The undersigned ownerrapphcant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages. costs. <br />expensesor causr , L action that may arise because of installation <br />I- and maintenance of the improvement or other ngf+of-way use hereto <br />applied for and turth or agrees to remove same upon notice from the <br />C,ty:,nd to replace public property damaged thereby. <br />Signature of Appl.cant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEPEAFTER IS TO <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 90 DAYS DURATION. <br />