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, <br /> , <br /> � APPlication For , <br /> PU�LIC WORK.�; PERMIT � °a�e— sili96 <br /> PUBLIC WORKS DEPAfITMENT Public Works Pennit# g <br /> � 3200 Cedar Stree�t <br /> Everett,WA 98201 2:i9-8810 Buildieg Permit# 51589 _ <br /> TYPE OR PRINT ONI.Y Public Warks Fee$ 3S�� <br /> Bk <br /> STARTZMAN 13i31 80TH �T SE SNOHOMISH 98290 653-1046 <br /> Owner Mailing Address City Zip Phone <br /> POKADOTS ESPRESSO DOTTIE BRO[1N 653-1046 <br /> Appiicant Mailing Address City Zip Phone <br /> �escribe Proposeci Y�/ork PLACG ESPRESSO STAND � <br /> � <br /> e <br /> -- //� <br /> ♦/♦ <br /> PROJECT ADDRESS(if known) 5705 EVERGREEN WY � <br /> Attach tc�r(q)copies of plans for proposed work-Draw to scale and note the following if applicable: � <br /> •Property Lines 'Outline and dirnensions of all existing and propcsed structures on the lot •Existing and proposed utllities O <br /> •Centerline of street •Indicate North •Show any proposed grading changes •Show measurements � <br /> DO NCT WRITE BELOIN THIS LINE <br /> PERMIT CONDITICNS: � <br /> 1. All cails for inspection shall be made 24 hours in advar�ce- phone 259-8810. O <br /> 2. All work shall be pertormed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOI.L FREE NUMBER 1-800-424-5555. � . <br /> i', L aca,�-.�- � S�x,.�� -�0 6e �z/,:.�� (� <br /> L�Lif �a�C QS /i7�/G2��G�" On 4�Tq �E� C//^¢ct/�/l� � O <br /> . a <br /> .�¢�,�4.Q��v,f� �Q�,.yc <br /> Gout{ro-� �Fev:c�o w c�c oe eu..t <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> /� / , The undersigned ownedapplicant hereby agrees to hold and save harmless <br /> � �p-�t s/, � the City of Everett trom any and all claims for damages,costs,expenses,or <br /> Approv� or Constructi ' Date � �auses of action that may arise because of fnstallation and maintenance of <br /> the improvement or other right-of-way use hereto applied for and further agrees <br /> < � r to remove same upon notice from the City and to replace public propeAy <br /> Gy(�I.�- •'y�.f/� da ged thereby. <br /> NA SPECTION Date � <br /> Approved as Constructed n . <br /> 1 ( <br /> Signatureof pplicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREA ER IS TO BE DILIGENTLI'PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY TNE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS OURATION. <br />