Laserfiche WebLink
� <br />Date �/4/�� <br />Application For <br />Pl7B�IC WORKS PERMiT <br />Print or Type Only <br />Public Works Pormn / <br />em�.ocP�.+ 91,/26568 <br />Pu�l�c Warks ico <br />Total Feo S — <br />Le55 ApPI. Fee Pa��d S_ <br />Dalance Ouo $ _ <br />Snohomish County Physicans Corp. 7600 Everqreen Way Everett 98203 <br />Owner Mailing Address City Zip Phone <br />Kirley–Cole PO Sox 1179 Snohomish 98290 568-3175 <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work Tenant itpj2Y^vamnnt <br />Proiect Address (il known) <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note the following as apalicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />a Centerline ot s�reel <br />• Indicate North <br />e Show any vroposed c�radin9 changes <br />b Show measurements <br />INE <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 25S•8810. <br />2. All work shall be pedormed in accordance v+ith liiis permit and current City of Everett Design and Construclion <br />Standards and Specifications. <br />3. Gall Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />1 v��c- r.�'o�s s�'.�v�.�.�Y � � � � <br />� �i <br />�n����� <br />�- �- y�� <br />ACKNOWLEOGEMENT OF CONDITIONS <br />W <br />� <br />�w <br />� / <br />� <br />v <br />� <br />� <br />d <br />The undersi�7ned owner/applicaN hereby agrees lo hold and save harm- <br />—� less the Cip• of Everett Irom any and all claims for damages, costs, <br />expenses, or ca��=es o( art�on that may arise because of installation <br />and maintenance of the improvement or olher right-ol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />Approved lor Consiruction �a�e City and to replace public property damaged thereby. <br />FINAL INSPECTlON Date <br />Approved as Consiructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�8870 <br />Signature o� Applicant Cate <br />WORIC AUTHORIZEO BY THIS PERMIT MUST 6E STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT h1AY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE O�' WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />