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�" <br />TYPE OR PRINT ONLY <br />�� pllcalion For <br />PUBLIC 1►VORKS PERMIT <br />PUBLIC WORKS DEPARTMEIJT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />;'� PQSTING �,aN z o ���:. <br />Date E, -3-97 ' <br />�'ublic Works Perrr,:� . 7% Z� 7- <br />i?�ilding Fermd k _ 55734 <br />3S do <br />F,nlic VJorks Fee 5 <br />�� � <br />Parsons Tuengel Partnership 19528 Larch Rd Snohomish 9E290 36�-�.91-4659 <br />Owner hL3iling Address City Zip Phone <br />M N R Constructioa Ron Sepanski 360-629-6613 mobile 206-290-29..? <br />Applicant Ltailing Address Cily Zip Phone <br />Describe Proposed Work Soecial Interest Auto Body site work <br />PROJECT ADG'�SS frf kn��'�n` 6400 Evergreen Way <br />Attach four (4) co�= �� cans ta- p;��. :� work - Draw to scale and note t� •`. :v: ing it appli�=- �, <br />°Property Li^ts butline and Uimensions of all existing and pmpos=:. �.:-. on the loi '= -�e�r �.�r-.�,, ,,.;�oosed utilitien <br />��>-dedine of sl�c��l 5ndicate North •Show any proposed g:a:; �� changes •Shov: ��� �����y�ents <br />"�'�r tl^ 'ii'7 ^'MPM <br />DO N�?T vVHITE BELOW THIS LINE y -' �7�� <br />I'I-1lMIT �oNDITIONS: Sl1RCHARGE 421.21 <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-88��,CFCi <br />2. All work shall be performed in accordance vdith this permit and current Citg�lp�,�q��tt Design and <br />Construction Standards and Specifications. �,`l.� <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE N�j'��(�1-�@�4,�4-5555. <br />� SURCHAP,�� Y.50 <br />/( ��i% B.�J'�rr/„f� /�E,� �"iTy .57���� '�`StGZ OTHER 97�f0 <br />TDTAL 4�6.�1 <br />.� CL��n -cufS �� Ce'�� Sf��,d'Yt`lc0¢ Ct-YEh' <br />A OM1233 <br />�i. �D%�r"�.'E To 1NOvS�iqG PP�� TP_FATir�,E"niT .f�E'QU��eF�,�r'NT <br />7 /. � .,,L ' <br />!'U�7� C/77( 4 S E4.5?M�n/ �j�. S�GJ4�r/- <br />� /i'7�iDi/� MC�If1 _ <br />� <br />ACKNOWLi.DGEMENT OF CON�ITIONS <br />The undersigned owner/applic;fnt hereby agrees to hold and save harmless <br />ihe City of Everett from any anC all claims for damages, cosis, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the impmvement or o�her riyht-oF-way use herelo applied (or and further agrees <br />to remove same upon notice (rom �he City and to replace publlc property <br />damaged thereby. <br />� <br />SignaWre of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />