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Date_— Ivw.e wwv. Peron . <br />A npL[eh,_ o, 6iep 0.11 . <br />PU13LIC WORKS PERMIT Mni.w°•..!• <br />Uu.PP� q. P.b s <br />Print or Type Only <br />check N <br />APP11cat.oatar 8 381/66 <br />09/21 <br />Job AOwner, 7NICK D7112ST <br />SEPA <br />Owner SN Phone <br />ProposedTenant, OI.SON BRUCE <br />De" LeeWOrkr <br />INSTALL rI <br />rWREE <br />Appl¢anl OOSF <br />CXAIRL Phone <br />RAMP <br />OFFICE SET <br />Describe Proposed Work APPRVD FOR P — JOB SET — <br />—/� By <br />', ` <br />W <br />Project Address lit known) <br />liesser <br />Attach lour (4) copies of plane for Proposed work - Draw to scale and note the following as Applicable: <br />aaas� <br />• Property Lines • Cenledine of street <br />0/\ <br />. • Outline and dimensions of all existing and • Indicate North <br />Cn <br />proposed structures on the lot • Show any proposed grading changes <br />• E.isling and Proposed utilities • Show measurements <br />Y <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />0 <br />1. All calls for Inspecliun shall be made 24 hrs. In advance • phone 259.8810. <br />ass) <br />2. All work shall be performed In accordance with this permit end current City of Everett Design end Construction <br />Standards and Spaclllcallona <br />3. Cell Location Underground Service 48 hr& before youdlg TOLLFREE NUMBER 1-800.424.5555. <br />Z <br />0 <br />/0.9 92 <br />0 <br />Approved for Construction Dale <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIL WORKS DEPARTMENT <br />3200 Cedar Street <br />ff Everett WA 99201 <br />Phone: 259-SPIO <br />`a1 <br />ACKNOWL EDOEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby egress to hold and save Term. <br />lase the City of Everett from any and all claims for damages, coals, <br />expenses, or causes at action that may arse because of Inspllallon <br />and maintenance of the Improvement or other rlght•obway use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST DE STARTED WITHIN <br />180 DAYS OF DATE PERMIT 15 ISSUED AND THEREAFTER 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 />