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F.,,._ .. - -.j <br />o.t��s , <br />.� <br />i <br />�� ApPlicatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type On{y <br />Sunrise View Convelescent Center 2520 Madieon <br />Everett <br />- -- _-- �- �--_� <br />PuElic Wods Perm�t • '`�� � <br />aitlp.oeot.+ � T <br />Pu01i[WontFee 3443--- <br />Totel R a / <br />Less Appl Fea P�id : •yi, <br />Balence D�� <br />98203 353-4040 <br />Owner MaiNng Address , Ciry Zip Phone <br />Solie Huilders <br />ApPlicant <br />Describe Proposed Work <br />Praject Addresa �if known) <br />7514 Juniper Drive <br />Maiting Address <br />Conatruet Convaleacent Center <br />Everett 98203 353-2331 <br />City Zip Phone <br />Attach four (4� copies oi plans tor proposed work • Draw to scale and note the following as applicable: <br />� • Property Linea • Centedine of street <br />� • Outline and dimensions of ail ezisting and • Indicate North <br />. proposed structurea on !he lot • Show any proposed grading changes <br />• Existing end proposed utiliiies • Show measurements <br />_ PERMITCONDITIONS <br />1. All cells for inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />�� 2. All woik shell be pertormed in accordance with this permit and current Ciry of Everett Design and Construction <br />- Standerds and Specificatlona � <br />3. Call Locatlon Undergrountl Service 49 hrs. before you dig. TOLL FHEE NUMBER 1•800•424•5555. <br />.�, 1�-�-�- � ro�-��L � sf�s /J G , /� , <br />v.�:.� `�� �l �� <br />� <br />��� <br />FINALI�SP <br />Approved as <br />everett <br />e <br />PUBLIC WORKS D <br />3200 Cedar Street <br />Everett, WA 98201 <br />Ph�ne: 259•88 7 5 <br />Date <br />ACKNOWLEDG[MEN! OF CONDITIONS <br />W <br />H <br />�� <br />The undersigned owner/applicant hereby agrees to hold and save harm- ' <br />less the City ot Everett from any and all ciaims for damages, costs, � <br />expenses, or causes of action that may arise because ot installation �� <br />and maintenance of the improvemenl or olher right-of-way use hereto <br />applied for and further agrees to remove same upon notice trom the � <br />Ciry a replace public property aged thereby. �. <br />l � /�_� � <br />ignature of Appli t Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED ANU THEREAFTER IS TO <br />8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOHK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />