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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Check No- <br />Applicat.Date: <br />Job Address: <br />Owner Owner: <br />Tenant: <br />Proposed Use: <br />DeBC. of Work- <br />T.I. — 27805F <br />Applicant <br />B 42080 SEPA <br />09/20/93 <br />2930 WETMORE 1ST FLOUR <br />CITY OF EVERETT <br />PLANNING DEPT <br />OFFICE <br />Public Wort Permit a <br />Bldg. Daps e <br />Public Worts Fee <br />Tmal Fee <br />Len APoL Fee Paid <br />Balame Due Ill <br />1ST FLOOR WALL ST BUILDING <br />OFFICE SET —JOB SET_ <br />Describe Proposed Work _ APPROVED FOR PERMIT: <br />DATE_/_/_ BY <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to sca;< and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hra. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hra. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />PUBLIC WORKS PERMIT <br />NOT REQUIRED <br />By ` i <br />DATE _ <br />Approved for Constructor Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />WORKS DEPARTMENT <br />J&E7rPUBLIC <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />O <br />z <br />O <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett born any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove some upon notice from the <br />City and to replace public- property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />