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- �- Pu6�ic wo�Ks <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Evcren, WA 00201 <br />��ZS'25�-�.9�o POSTING Aur, z n 200� <br />SAFEWAY <br />1121 124TH AVE NE <br />BELLEVUE WA <br />PHONE: � Q�5 ) 455-8670 <br />TA% PARCC-L I.D. a S <br />DESCRIPTIONOF j�jEW GAS STATION <br />PFOPOSED WORK: <br />� <br />PERMIT C.ONDITIUNS <br />APPLICANT NAME <br />ANDADDRC-SS: <br />98015 <br />PHONE: <br />PROJECTADDRESS: <br />Date <br />Public Works Permit a <br />Building Pcrmil q <br />Planning Relemnce # <br />Public Works Fec S <br />Guarantee 5 <br />io/i2/2oo0 <br />PW('010-013 <br />8�01�-�14 <br />$ 753.00 <br />1. All calls lor inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be performed in accordance wilh ihis permit and current City of Everelt Design and Constructior, <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555 <br />4. As per the approved plans dated 12/11/00. <br />1�-21-00 2:37F'�-i <br />{� ��.1.��14 <br />FIJII_D 138.75 <br />SRCHG 4.50 <br />ti 0012015 <br />SEWER 70.00 <br />H 00100013 <br />OTHEIt 10�.OD <br />fW/RUW 216.U0 <br />F'W/TNSP 432.00 <br />TD1AL 966.25 <br />A Oh 816 <br />WL <br />r <br />♦�� <br />V� <br />W <br />�^ <br />/ <br />Z <br />� <br />� <br />� <br />� <br />f :i 7E(,'. 5�5 <br />ACKNOWLEDGEAdENT OF CONDITIONS <br />� I� /�� The undcrsigned owner'applicant hereby agrees tn hold anJ <br />save harmless Ihe City ol Everell Irom any and all claims for <br />npp� ved �or msimcu n oa�e damages, costs, expenses, or causes of action Ihal may arise <br />because ol installation and maiNenance of Ihe improvemem or <br />' � other riohbo4way use hereto applied lor and further agmes to <br />� �, �(W..-- 4-3 —� remu same upon noticr. Irom Ihe City and to replace publir, <br />FINAL INSPEC�i ION prop damag�d th ��. <br />Approvetl as Constmctrd Dale <br />� _ ���-12��IJ��oo <br />Si9na1 ne ol Appli[anl Dale <br />IVORK �U7HORIZEC eY THIS PERMIT MUST BE STARTED WITHIN 780 DAYS OF OATE PERh11T IS ISSUED AND 7HEREAFTER IS TO �E DILIGENTLY PURSUED <br />TO COh1PLETION. THIS PERMIT IdAI' BE CA.JCELLEO BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER SU DAYS DURATION. <br />