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� <br />Ti PE OR PRINT ONLY <br />Owner <br />Applicanl ' <br />�plicalion For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS OEPAR i MENT <br />3200 Cedar Slrcet <br />Everetl, WA 98201 259-8810 <br />Dale — <br />Public Works Permil W <br />Building Permit N _ <br />Public Works Fee $ _ <br />Plan Check Nos B 53214 SEPA <br />Appllcat.Datei 10[15�96 <br />Job A�ne==6STRICKI,ANDYJEF� <br />Tenants <br />Propoeed Uees ESPRES::O <br />Desc. of Work: <br />ESPRESSO STAND <br />Describe Proposed Va�O�k _ OFFICE SET JOB SET <br />APPRVD F0I2 PERMITt DATE_/_/_ <br />PROJECT ADDRESS (if known) <br />Altach four (4) copies of plans lor pmposed work - Draw to scale and note tho lollowing il applicable: <br />•PropeAy Lines •OuUine and dimensions ol all eaisting and proposed simcWres on the bt 'Existing and proposed utilities <br />•Centerline of street •Indica�a No�th •Show any proposed grading changes 'Show measuremenls <br />.... .��T �n�oiTG aFl (1W THIS LINE <br />Phona <br />Phone <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Undergromd Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />'UBLIC ':vONt<S PF_RM�' <br />�.O i EO �RFA <br />�v _1/..��9G <br />�P.TS_'_"_' '��• <br />,�pproved lor Construclion Date <br />FINAL INSPECTION Date <br />qpproved as Constmded <br />r//� <br />V♦ <br />OA <br />�i <br />ACKNOWLEDGFMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees lo hold end sava harmless <br />the Cily of Everelt Irom any and all claims lor damzges, cosls, ezpenses, or <br />Ihe mprovem nto otherYgFt o1-wayuseher 1'appliedlorandluAheragrees <br />to remove same upon nolice from ihe City and to replace public property <br />damaged the�eby. . <br />Datr. <br />Signature ol Applicant <br />COMPLETION.RIHEDB RMIT hAYHBE C NCEL ED �1�' THDE CIT`.'IUP'ON PNY SOTOPPAGE OF'WORK ON THIS PROJECT OVEF 90 0� S D�UIRATEONLY PURSUED TO <br />