Laserfiche WebLink
4$.� <br /> � nl <br /> �� 7-29-91 �,,,,q . � auoi�c woika Vermn• � <br /> Date 91/27906 � <br /> sm�.oeo�.• <br /> � Applicalion Far <br /> PUBLIC WORKS PERMIT PUOTOIaFeaF�� 5 <br /> Less ROP�Faa Pe1G S �, <br /> Balanco�ua $ <br /> ��� Print or Type Only ' <br /> 9H � <br /> [�rx+ Readicare (Chec Medical) 2600 Michelson Dr #1130 Irvine CF+ 92715 (714) 476-8743 <br /> �-a. x N Owner Mailing Address City Zip Phono <br /> K z c�i �46HHX Samuel Park 11416 Slat�r Ave NE #100 Kir':land 98033 622-8473 <br /> p� H� Applicant Mailinc�Address Cily 21p Phone <br /> U1 H <br /> xZ 3 Describe Proposed Work TI � medical office ; <br /> C7 O t+� <br /> OHd <br /> H �g . � I <br /> �� � <br /> z i-+� � <br /> �-ai ~'z Projet�Address(il known) 8609 EVEI reen wa <br /> HH <br /> gN H Attach four(4)copies ol plans for proposed work-Draw lo scale and note the following as applicable: � <br /> n �y y • Property Lines • Centerline ol slreet `^ <br /> 7 <br /> � C� • Outline and dimensions ol all existing and • Indicate North <br /> ��� proposed simctures on the bt • Show any proposed c�radin9 chan�es <br /> y Oy N . • Existing and proposed utilities • Sho�x measuremenis /�/�j I <br /> W � <br /> DO NOT WRITE BELOW THIS LINE � I <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be mede 24 hrs.in advance•phone 259•8810. � � <br /> 2.All work shell be peAormed in accordanea wilh this pe�mit and currenl Cily of Everett Design and Construclion I <br /> �i Standartls and Speciticationa <br /> 3.Call Lxation Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. ' � � <br /> � � <br /> w� ��\] <br /> I `/ I' <br /> � (�j !'vGQ-�, !,�/or�"-� �ta2r�wl� /��o7Q �'�-�-u�c'� � I <br /> i :,���--/- (� <br /> �`` � ;. i� <br /> ,�� 7- . O <br /> � .:.�� a : <br /> �� I <br /> �— ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- . <br /> less the Cily ol Everelt Irom any and all claims for damages. costs. <br /> v expenses, or causes ol aclion that may arise 6ecause of installation � <br /> f ' � and mainlenance of Ihe improvement or other righFobway use hereto � <br /> � <br /> applied lor and funher agrees to remove same upon notice Irom ihe <br /> Approved lor Constructlon �a�e Cily and tc replace public property damaged thereby. � <br /> a. ' i <br /> FINAL INSPECTION �a10 Date <br /> Approved as Consirucled SignaWre ol APPI�Cant <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMITIS ISSUED AND THEREAFTER IS TO <br /> � 32DOCedarSlreel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERM1IIT�dAY BE <br /> Everott,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phono:25&8810 pROJECT OVER 90 DAYS DURATION. <br />