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� �Ikelfo� For <br />PUBLIC WORKS PERMIT <br />PUBLIC WCRKS DEPARTMENT <br />3200 Cedar Slreel <br />EvereB, WA 99201 (425) 257-BB10 <br />Mov o i zoo� <br />TYPE OR PRINT ONLY <br />�� P�STING Nnv � � ',,"; <br />Daie C9909-006 <br />Public Works Permlt M �� • `I _�"� <br />Auilding Permit N 9/8/49 <br />ev <br />Publ� Works Fee S � <br />CURU BROTHERS LLC 1133 164TH ST SW ►104 LYNNWOOD WA 98037 <br />Owner Meiling Address Ciry 21p Pha�e <br />CONTACT: dUSS SMITII 206-323-8133 <br />Appllcant Malling Adtlrase Clly 21p Pfwne <br />Describe Proposed Work <br />CONVEAT SFR TO MEDICAL CLINIC <br />PROJECTADDRESSQf known) ____�B14 1 <br />i? <br />Allech lour (4) coplee plene for propoae0 wo�k � Drew to ecale entl note ihe Idlowing II epplkable: <br />• P/aperry Llnes • Outllna end dimenslona of all evistlng entl p�opoaetl atructwes on tl�e bt • E.lenng end propoeed uMinee <br />• CentaAlna ol etreet • Indicete North • Show any proposrtd greding changes • Show meea�vementa <br />DO NOT WFtITE BEl OW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspe�tion shell be made 24 hours in edvence - phune (425) 257-8810 <br />2. All work shall be peAormed in eccordance wilh this perm+t end current City af Everett Deslgn and <br />Constructfon Standards end Specilications. <br />3. Call Locetion Underground Service 48 hrs. Gefore you dig. TOLL FREE NUMBER 1-800-124-5558. <br />�, ,45 p� ��Prnved �fil�� s dA�d I � � �S ��1� . <br />W <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />o�..,,,� <br />ACNNOVYLED6EMENT OF CONOITIONS <br />The underslgneE owner/eppllceM hergby epreee to hoW enA enve hurtnlaes <br />the C�ry ol Everen Irdn any aM a11 claimn for demagee, co�b, eapansee, p <br />C8lMQ6 0l BCtlOfI Ihe� IIWy sAle bBC8U89 01 IM�YII�tl011 8fld mBk1�E1MlICB O� IIIB <br />knprovament a Mher righlol�wey uee MreM epplled br and lurlhai eprees b <br />iemove nrnke Gry to replxe P�k ProMM dam- <br />eged reby. _ <br />i '3 . <br />re o icen e a <br />WOfiY, AUf1qR�D BV THIS PEFMff AR1ST BE STAFiTED VVfTNM! 180 DAYS OF DATE �EFi�MT IS IS9UEn MD 71EFEAF7ER I'7 TO BE DUOENTLV PURffiJED TO <br />COI+PlEf1pM. h'!S PEF7�MT MAV BE �'•AN('.EUED BV 7}E CfTV U'ON ANY 5701'PMLiE OF �M71�( dJ THS PHO,ECTOVER 90 DAVS DURATION. <br />� <br />