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Date Public Works Parma• _ <br /> Application For Blau pool <br /> PUBLIC WORKS PERMIT Public Woraa Fee <br /> Tc1aIrks S <br /> Less fool Fee Paid S — <br /> Balance Due S <br /> Print or Type Only <br /> Plan Check No: B 39361 SEPA <br /> Owner Applicat.Date: 01/26/93 Phone <br /> Job AddrB: 1410 BOTH ST SW BLDG B STE F <br /> Owner: FAGERHOLM CO <br /> Tenant: SCAN AMERICA SEAFOOD CO <br /> Proposed UBe: OFFICE 6 WAREHOUSE <br /> Applicant Deac. of Work: Phone <br /> TENANT IMPROVEMENT <br /> Describe Proposeu Work — OFFICE SET JOB SET <br /> -- APPRVD FOR PERMIT: DATE_/_/_ BY__ <br /> W <br /> Project Address(if known) — <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable. tt� <br /> • Property Lines • Centerline of street /A <br /> • Outline and dimensions of all existing and • Indicate North �'♦ <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> DO NOT WRITE BELOW THIS LINE WO <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 Specificallons. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. <br /> O <br /> •'UBLIC WORKS PERMIT <br /> NOT REpUIRED <br /> UY _ O <br /> DATE Z�' � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance of the improvement or other right of-way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved for Construction Dale City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PFRMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Vff 3200 Cedar Street BE DILIGUNTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:2598810 PROJECT OVER 90 DAYS DURATION. <br />