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Date 1/31/95 <br />Applicallon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pubiic Wods Parmil � <br />Biae.Dopt.. /(,R�,7 <br />PumicworksFea 5 <br />Tolnl Fee <br />Less Aoo�. Fca Paia $ <br />Balance Oue � <br />McDonalds 102 0 N� Points Dr Kirkland 980'i4 427-9700 <br />Owner Mailing Address City Zip Phone <br />Dave Pioe 961-7656 <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed work Install steel columns for awning over existing playground <br />Prolecl Address (if known) <br />Attach four (4) copies ol plans tor proposed work - Draw to scale and note �he tollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions ol all existing and • Indicale North <br />proposed structures on the lol • Show any proposed grading changes <br />• Existing and proposed ulilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspeclion shall be madc� 24 hrs. in advance- phone 259•8810. <br />2. All work shall be per(ormed in accordance with ihis permil and current City of Everelt Design and Construction <br />Standards and S�ecilications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-500•424•5555. <br />/�� �w r�' <br />, �,,� �%-- <br />2�����_ <br />/ <br />Approved lor Construc�ion <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />�w <br />7 / <br />� <br />O <br />� <br />� <br />0 <br />a <br />The undr.rsigned owner/applicanl heieby agrees to hold and save harm- <br />less the City ol Everetl Irom any and all claims lor damages. cosls. <br />expenses, or causes of �ction that may arise because of installation <br />and maintenance of the improvemenl or other rigM-oFway use herelo <br />applied lor and further agrees to remove aame upon rotice from the <br />Date City and to replace pu6lic property damaged thereby. <br />FINAL INSPECTION Date <br />Approved as ConsVucted <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Ecerett, WA 98201 <br />Phone: 259�8810 <br />Signature of Applicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST 8E STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DILIGENTIY PURSUED TO COMPLETION. THIS PEAMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEF 90 DAYS DURATION. <br />