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'� '%n_ - <br />,-. � .- - <br />Date <br />Application For <br />PU�LIC WORKS PERMIT <br />Print or Type Only <br />rumic wo.w. anmu . <br />Bi0p.0�o��� -- <br />PuDuc Wort� Fa� s <br />TM�� F�e <br />l�u ApO� Fae P��E s_ <br />B�I�nce Du� <br />Plan Cheak No: B 44110 SEPA rnone <br />Owner Applicat.Date: 04/15/94 <br />Job Addreee: 2221 STATE ST <br />' Owners VICKONOFF MARK <br />Tenartt: Phone <br />Appiicant Deec�ofdWorke CARAGE <br />DET11CHfiD CARAGfi <br />Describe Proposed Work _ <br />OFFICE SET JOH SET � <br />11PPROVED L+'OR PERMITs DATS_/_/_ By <br />Proiect Address (il k�own) - <br />Atlach lour (4) coDies ol plans lor proposed work • Draw to scale and notr the following as applicable: <br />• Property Lines • Centerline ol street <br />• Outline end dimenaions ot all existing and • Indicete North <br />propoeed structures on lhe lol • Show any proposed greding changes <br />• Ezisting and proposed utilities • Show measurements <br />PERMIT CONDITION3 <br />7. All calle for Inspectlon shell be made 24 hrs. in edvence • phone 259•881 O. <br />2. All work shdl be peAortned in accordence with this permit and curr3nt City ol Everett Desipn and Construction <br />Standards and Specificatlons. <br />3. Cell Localion UnderprounE Service 48 hrt. belore you dip. TOLL FREE NUMBER 1-800•424-5555. <br />PUBLIC WORKS PERh11T <br />NOT REaUIRED <br />BY <br />DA"f E <br />Approved for Construction Dale <br />FINAL INSPECTION Date <br />qpproved as Conslructed <br />�PUBLIC WORKS DEPARTMENT <br />3y�,00 Ceder Street <br />EveretL WA 98201 <br />Pnone:259•AA10 <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/epplicant hereby agrees lo hold and save harm• <br />less the City of Everett irom any and al� claims for damages. costs, <br />ezpenses, or causes of action thal may arise because of installelion <br />and maintenance of the improvement or other right•of-way use hareto <br />Applied for and further agrees to remove same upon notice Irom the <br />Cily and to replace public property damaged thereby. <br />Oale <br />Signature ol Applicant <br />BOFDAYSTOFORDATE PERMIT ISEISSUED ANDB HEREA TER IS TO <br />CANCELLED 8Y THE C TY U ON�NV STOPPAGEIOF WORK ON THIS <br />nn� �rrT /1�rrn nn n�.YC I��m��TIr1N <br />