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TYPE OR PRINT ONLY <br />Ownar <br />Ap m Fa <br />PUBLIC W I�KS PERMIT <br />PUBLIC WORKS �EPAqTMENT <br />9200 Cedar Street <br />Everott, WA 88201 259•BB70 <br />ApPlicent Mallir <br />Describe Proposed Work <br />FROJECT ADDRESS (f known) <br />Dete � <br />Pu61ic Nbrks Permit / <br />Butldlnp Pertnit 1 _ <br />Publle Nbrke Fss S _ <br />Plan Chack No� B 59029 &EP]► <br />Applicet.Date: 06/03 98 <br />Job Address� 1520 12TH ST SW <br />Owner= HOLT6EERT8 REF.D <br />Tensnt � MGS C71aE <br />Propoead Uoe: RSTAIL/BTOMOE <br />Dasc. of Work� <br />2 BTOAY ADDITION WITH Bl1SSMBNT <br />OFFICE SET JOB 86T <br />APPROVED FOR PEAHITt DrT6_/_/_ BY <br />4 tlach four (4) coplas of �lana lo� proposed work - Drew to eeale end r:ote the falbwing If applicable: <br />Phone <br />Phone <br />•Property lines 'Outline and dlmenaione of atl exlatlnp entl prt,posetl elructures on the lol •EMlstinp end proposed utllltles <br />•Centerlina ol nlreel •Indicale Norlh •Shaw arry propnaed gredlnp chengee •Show meaaurements <br />PERMIT CONDITIONS: <br />t. All calls for Inspection shall be made 2�1 hours In advance - phone 259-8810. <br />2. All work shall be performed in accordarce with this permit and current City of Everett Design and <br />Construction Standerds and Specificatlons. <br />3. Call Location Underground Servlce 48 hre. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />`iJDUC WpRK� �ERMII <br />KOt qR�6�0UIR�� <br />ry_�^I <br />•�TF.-'.--��n�` . <br />1 <br />�. <br />Approvad for Construcllon Oate <br />FINAL INSPECTION Date <br />Approved as Constructed <br />ACKNOWIEDGEMENT OFCONDRIONS <br />The underaignad owner/epplleant hsrohy aprees to hold and eeve harmlesa <br />the Clty of Everett Irom eny ond all clelms for tlamagea, coete, eapense�, or <br />ceueae of actlon that mey erise beeausa of Ineteilatbn and melntenanca ol <br />Iha Impovemenl or olher rlght-ol-wey use hereto applled fnr and IurtAer apreas <br />to rertwva eame upon notice from the City and Io replace pubilc property <br />damaped tAercby. <br />Slpnaturo ol Applicanl Date <br />WOf;K AUTHORI2ED BY TIIIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMR IS ISSUED AND THEREAf'fER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEf1pN. THIS PENMIT MAY BE CANCELLED BY THE CI7V UPON ANY STOPPAGE Of WORY. ON THIS PR0.IECT OVER 90 DAYS DUMTION. <br />