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y N <br /> G � <br /> [V <br /> b x <br /> C � PubLCAYo�kepeimi�� _ <br /> � � � Date __ <br /> ��iao.oeo� • <br /> �] � Application For <br /> � � � �UBLIC WORKS PERNiIT FVCToIai�FaeFeo 5 <br /> � N ta '_ <br /> � Lessnoa�Fee va�a 5 <br /> ro � - <br /> eaiance oue g <br /> � � � Print or Type Only <br /> � `� j <br /> z H � SEPA <br /> y Plan Check No: B 37056 <br /> r f+ y Owner Applicat.Date: 06/16/92 <br /> n Job Addre: 1330 ROCKEFELLER STH FLOOR Phone <br /> pp N Owner: GENERAL HOSPITAL <br /> f] O N Tenartt: <br /> � � �., propoeed Uae: HEDICAL OFFICE BLDG pi�,one <br /> � Applicanl Desc. of Work: <br /> y •� y T,I, - 1037SF <br /> Oescrihe Propased Work OFFICE SET�—JOB SET <br /> — APPRVD FOR PERMIT� DATE__I__��. DY <br /> - W <br /> Proiect Address(if known) � <br /> Attach four(a)copies ot plans for proposed wo�k� Draw to swle antl note the lollowing as applicahle: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions ol all ezisting and • Indicate I�orth <br /> proposed structures on the lol • Show any proposed gratling changes <br /> " • Eaisting and prcposed utilities • Show measuremeNs M <br /> � �i�� W <br /> � DG NOT IYRITE BELOW THIS LINE O <br /> � PERMIT CONDITIONS � <br /> I7,All calls for inspection shall he made 24 hrs.in advance•phone 259•8810. <br /> � '�� 2.All work shall be Fedormed in accordance wilh�his permit�nd current City ut Everelt Oesiqn and Consiruction <br /> ��I Standards and Specifiw�ions. <br /> , 3.Call Location Underground Service 48 hrs.belore you diq.70LL FREE NUMBER 1•800•424•5555. � <br /> I �� O <br /> I , . � <br /> i � <br /> , � - n,., r, '� �./,� �. �' . ,�, <br /> (J/'e.e � .. . _ /'---�. ,.�.to'.._ _ <br /> i <br /> ��-� �/� O <br /> �_ � � � .. <br /> _ , a <br /> _�_ <br /> I ACKNOWLEUGEMENT OF CONDITIONS <br /> � �r' <br /> � The undersigned owner/:�pplicant hereby agrees to hold and save harm- <br /> less the City ol Everett from any anA all claims lor damages, costs, <br /> expenses, or causes ol action that may arise because ol installation <br /> and mainlenance ol Ihe improvement or other ri9hboFway use herelo <br /> applied for and lurther agrees to remove same upon notice from the <br /> Approved for Construction �a�e Cily and to replace puhhc propeny damaged therehy. <br /> FINAL INSPECTION ���� Dale <br /> Appreved as Conslructed Signalure ol Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �Ar� PUBLICWOFKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED ANO THEFEAFTER IS TO <br /> 3200CedarS�ree� gE DILIG[NTLY PURSUE�TO COM1IPLETION.THIS PERMIT �tAV BE <br /> Everett,WA 98201 I CANCELLED BY THE CITY UFON ANY STOPPAGE OF WORK ON THIS <br /> Fhonc:259�8810 pROJECT OVER 90 DAYS DURATION. <br />