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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No: B 37255 SEPA <br />Applicat.Date: 07 02 <br />Job 92 Address: 95 2 IR AVE BE SUITE A <br />Owner Owner: JOHNSON, RICHARD <br />Tenant: PRUDENTIAL PROPERTIES <br />Proposed Use: REAL ESTATE OFFICE <br />Desc. of Work: <br />TENANT IMPROVEMENT 4725 SF <br />Applicant <br />OFFICE SET JOB SET_ _ <br />Describe Proposed W APPROVED FOR PERMIT: DATE BY <br />Project Address (if known) <br />Public Wor" Permit <br />Bldg. Dept. a -- <br />Public Wor6e Fee $ <br />Total Fee <br />Less Epp: Fee Psid $ <br />Balance 0.0 $ <br />Zip Phone <br />Attach four (4) copies of plans for proposed work - Draw to scale and ncte the following as applicable: <br />r • Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot a Show any proposed grading changes <br />Y Existing and proposed utilities a Show measurements <br />Phone <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 cut rent City of Everett Design and Construction <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />41 ell <br />�e <br />7 G -9 z ✓ <br />Approved for <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />4 3200 Ceder Street <br />Everett WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />MINES!! <br />W <br />Im <br />O <br />Mali <br />O <br />O <br />a <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 />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS 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 />PROJFCT OVER 90 DAYS DURATION. <br />