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l�/ l 7 . � - 'i , �- � <br /> � APPliwtion For <br /> PUBLIC WORKS PERMIT °a�e i-23-9a <br /> PUBLIC WORKS DEPARTMENT P�olic Works PermN M ��S9 <br /> 3200 Cedar Street <br /> Everett,WA 98201 �B�Ot � guilding Permit a 57726 <br /> TYPEORPRINTONLY TO POSTING �---- publicWorksFee$_ Z4S � <br /> Singh Balbir 5130 138th St NE Marysville 98270 360 652 6066 <br /> Owner Mailing Address City Zip Phone <br /> Barghausen lori Hoover 425 251 6222 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work new ARCO convenience store ■ ■ ■ <br /> W <br /> � <br /> '.i.:� ' .:Ji � <br /> PROJECT ADDRESS(if known) 1806 Broadwa i� 577�6 <br /> ���i:� �_r�.�� W <br /> Attach lour(4)copies ot plans for proposed work-Draw to scale and note ihe following if applicable: r U/;;Gl,' 4.,`�0 O <br /> •Froperty Lines •Outline and dimensions of all existing and proposed structures on the lot •Existing Nntl proposed uti6fj�y� <br /> •Centedine o1 slreel •Indlcate North •Show any pmposed 9rading changes •Show measureriieritsii _ _;,i).CC � <br /> DO NOT WRITE BELOW THIS LINE �,��;�;; ;��,!';0 <br /> PERMIT CONDITIONS: '! �t",�r Z <br /> l. All calls for inspection shall be made 24 hours in advance-phone 259-88�q,:n :,,_�� o <br /> 2.All work shall be performed in accordance with this permit and current City�of-F�yerett D@si�n and <br /> Construction Standards and Specifications. ��,�,��F ,`����,�i� <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE I�UMB�R 1-800-IZ4-5555. � <br /> ,.,� r�� <br /> UiI_D 138.��0 <br /> � SrfiiWi; 4.50 � <br /> 4, C/vl� Wor�� �o d �er r:K�.c�ct <br /> �c one <br /> qPpro✓ed ���,,,s dQ�d 3-!(0-`18 5rRIirf; -a.sa � <br /> ;hCHG 4.SG � <br /> 3"UT�� �934.�� <br /> G-r�k c'4 ;:;:. <br /> i vu�C<? <br /> �� ACKNOWLEDGEMENT OF CONDITIONS <br /> / i The undersigned owner/applicant hereby agrees to hold and save hartnless <br /> 3 � 7 � ihe Ciry ol Everett 1mm any and all clalms lor damages,costs,ezpenses,or <br /> A ved f r2onst p Date causes of actior.that may arise because ot installation and maintenance ol <br /> ( / theimprovementorotherri9h4of-wayuseheretoeppliedforandfurtheragrees <br /> � to remove same upon notice from the City and to replace public property <br /> damaged thereb�r. <br /> FI INS ECTION Date <br /> Approved as Constmcted � p <br /> �C%�.;--?/ �lzv/y8 <br /> i atme of Applicant Tpate <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILI�ENTLY PURSUED TO <br /> COMP�ETION THIS PERMIT MAY BE C�NCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PRQIECTOVER 90 DAYS DURATION. <br />