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Date 9-28-94 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public WO" Permit • — <br />Bidp Debt • 45698 <br />Public Wbns Fee s <br />TWnI Fee <br />Leas APPI. Fee Paid i <br />Balance Due i <br />Bee Su Y1 2000 Broadway Everett 98201 258-5444 <br />Owner tdaikFig Address COY Zip Phone <br />Sang Shim 743-3548 Pager 991-8885 <br />Applicant Mailing Address City Zip <br />Describe Proposed Work _ espresso stand <br />Project Address (if known) <br />— _--- <br />Attach tour (4) copies of plans for proposed work - <br />Draw to scale and note the following as applicable: <br />• Pi operty Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />inn unT WRI1F RFI OW THIS LINE <br />Phone <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 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 hrs. before you dig. TOLL FREE NUMBER 1-800.424.5555. <br />PUBLIC WORKS PERMIT <br />NOT REOUIRED <br />ey _ <br />alATE � <br />�� rainy S�a LeS- <br />W <br />H <br />C4 <br />a) <br />O <br />n <br />z <br />O <br />IME <br />W <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ^f 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-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />Construction Date City and to rEplace public property damaged thereby. <br />FINAL INSPECTION Date Date <br />Approved as Constructed SignatureWORK ORK A of Applicant <br />AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />PUE:IC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259-8810 PROJECT OVER 90 DAYS DURATION. <br />