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Date___ <br />Application For <br />PUBLIC WORKS PERMIT <br />�rtnt or Type Only Plan Check No: B 41105 SEPA <br />Applicat.Date: 06/25/93 <br />Job Address: 3901 HOYT AVE <br />Owner: EVERETT CLINIC <br />Tenant: MICROBIOLOGY <br />Owner _ Proposed Use: MEDICAL <br />Desc. of Work: Zip <br />TENANT IMPROVEMU19- 640SF <br />Applicant OFFICE SET <br />Describe Proposed Work <br />Project Address (if known) <br />JOB SET <br />APPROVED FOR PERMIT: DATE_/_/ <br />BY <br />Zip <br />Public Works Permit a _ <br />Bldg. Depl. a <br />Public Wc. ,Fee $ <br />Total Fee <br />Less APPL Fee Paid $ <br />Balance Due $ <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all exi ing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shalt oe made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be performed in accordance with tnis permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />Approved for Construction <br />:UBLIG <br />WORKS <br />REOMIT <br />UIRED <br />NOT <br />BY <br />DATE (' Z9 <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />7r Everett, WA 98201 <br />Phone: 259-8810 <br />n <br />I <br />1 <br />mm <br />z <br />0 <br />O <br />am <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from 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-ol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace p0lic property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 ZIA''S 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 />