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� � � <br /> � � <br /> � yv, <br /> ~ � � �i <br /> KH b ,. v�ei�cw�,.:rc�mn. -- <br /> ro ,�, °y , Date emu 000� ._ <br /> N N <br /> y Applicalion For <br /> � � � I <br /> � PUBLIC WG`RKS PERMiT rooi�cwoinaFee s <br /> Totel Fre <br /> M � �QJ �� Lesa Rppl Fee Poid S <br /> GI • f7 ' Baianca Dun 5 <br /> H -- — <br /> � H z I Print or Type Only <br /> � H � I <br /> ; SEPA <br /> � � r �, Plan Check No: B 3/7164 _ qTH FLzi�� Phone <br /> yee Owner APPJobaAddree•1�3bzROCKEFELLEA AVE <br /> o U � Owner: GENEAAL HOSPITAL MED CTR <br /> '� Tenant: — <br /> I� propoeed Uee: MEDICAL OFFIC6S ,�n Phane <br /> Applicarl Desc. of Work: <br /> RF.LOCATE JANITOR CLOSET <br /> Describe Propased Work _ ,708 SET.�� <br /> OFFZCE SET�� <br /> pppAVD FOR PERMIT� DATE_/��� BY <br /> ' h <br /> I Ptolerl Address(il known) <br /> �� <br /> Attach lour(A)copies ol plans lor proposed work-Oraw to scale and note thr iollowing as apP�icab�e: � <br /> �� � � • Property Lines • CeNerline of sireet <br /> � �� ' • Outline and dimensions ol all eaisting and • Indicate North <br /> � i proposed slructures on Ihe lot • S�iow any proposeC yrading changes <br /> � 'i • Existing and proposed utilities • Show measurements � <br /> 1 I <br /> '� � DO NOT WRITE BELOW THIS LINE O <br /> ��� I <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 pedormed in acccrdance with this permit and curreN City of Everetl Design and Conslruction ♦ <br /> r�� Standards and Specilications. � <br /> � ��� 3.Call Location Undergmund Service 48 hrs.belore you dig.TOLL FREE N!'MBER 1•800•424•5555. <br /> � � � � � � . . . ,- �<-�� ��f� ,�C�' � <br /> ..��I � ` <br /> ,_� . �♦^ <br /> � _ V♦ <br /> ���"� . (� � � � � <br /> ���_�w� <br /> a <br /> ACKN0INLHDGHMENT OP CONGITIONS <br /> The unde�signed owneUapPliCant hereby agrees to hold and save harm� <br /> less Ihe City ol Fverell irom any and all claims lor Aamages, costs. <br /> ezpenses, cr causes ol aclion Ihat m,.y arise because ol installation <br /> and mainlenance of the improvemenl or other right�of�way use liereto <br /> applied �or and furlher agrees to remove same �ipon notice Oom Ihe <br /> Approved lo� Consuuetion Date Ciry and w replace public pronerty Aamaged ihereUy. <br /> FINAL IPSPECTION Da�e -- — ���� <br /> Approved as Constructed <br /> S, �ol Ap,��icar.' <br /> WOHtt AUTHORIZED Bl' THIS PERMIT MUST BE STARTED WITHI <br /> �7 PUBLICWORKSDEPARTMENT 1ti'1 DAVS OF DATE 'ERMIT IS ISSUED AND THEREAFTER IS 70 <br /> '�� 3200 Cedar Slreet BE L'UPENTLY FURSUED TO COMPL[TION. THIS PERMIT MAY BE <br /> Everc�t,Wn 9820+ CANCELLED BY T`i[GITY UPON ANY STOPPAGE OF WORK ON iH15 <br /> Phanc:259�8010 �An IF�T f1�ICR nn,IAVA M IF,ATI!1N <br />