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� u °�STING ��I� �i �' 'i`' ;� <br /> Appli4�6on For <br /> PUBLIC WORKS PERMIT Date �Ii13i9s _ <br /> " 4fo <br /> PUBLIC WORIFb DEPARTMENT Public Works Pertnit N _�� <br /> 3200 Ce�er Street <br /> Evereri,WA 98�1 259-8870 Building Permit N �t.�_ <br /> TYPE OR PRINT ONLY � �" �' � � m Public Works Fee S �� <br /> d .�-� N M � F <br /> tn r^ .n a� <br /> BP i,�l (Johnston Petrole m) ;g�3� Fedecal Ave 98201 252-1179 <br /> pwner Mailing Addmss o. � = r, ^- City 2ip Phone <br /> � � c� " x � c�S <br /> Eric Warnat 742-494�',. e�`�1�� tg � _ <br /> Applicant Mailing Address City Zip Phone <br /> DesCribe Proposed Work New canopy, mpd'e and diesel dispenser � <br /> � <br /> � <br /> � <br /> PROJECT ADDRESS(if known) z802 Hewitt � <br /> Atlach four(4)coples oi plans for proposed work-Draw to scale and note the foilowing if applicab�e: O <br /> �piopany Lines 'Outline and dimensions of ell existing and proposed sliuctures on the lot 'Ezfsting anA proposed utilities <br /> 'Centerlina of straet 'Indicate North 5huw any proposed greding changes 'Show measureme�its � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. O <br /> 2.All work shall be performed in accordance with this pertnit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-b555. H <br /> Q• f�5 PCi' � �Gln Sv �J' rn:�P.G w� �h� . � <br /> � <br /> a <br /> ACKNOWLEDGEME�T OF CONDITIONS <br /> �� ,_ I^�, / /�� The unuersigned owner/applicant hereby agrees lo hold and save harmless <br /> �Y/Li/.,i �� �� the Ciry of Everett from any and all claims for damages,costs.expenses,or <br /> F•'��� causes of aclion that may anse because of installation and maintenance ot <br /> ApprovedforCons�p ctlon �e 7— theirnprovementorotherright-ot•wayuseheretoappliedforandfurtheragrees <br /> %� to.amove same upon notice from the City and to replace public pro p e�t y <br /> � _� f� aamaged .reb . <br /> FINA SPECTION Date <br /> p,pproved as Constructed ��7� (� <br /> Si natureotApplicant Date <br /> WOFK AUIHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE OILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />