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Date 9-12-94 <br />Application For <br />PUBLIC WORKS P�RMIT <br />Print or Type Only <br />Ashier Bourne <br />Ow�er <br />Owner <br />ApFlicant <br />Describe Preposed Work _ <br />Project Address (il knownl _ <br />15 124th P1 SW Ill <br />M:;ihng Address <br />espresso stand <br />� <br />�}:r.. <br />Al. <br />,o <br />u <br />0 <br />� <br />O <br />S <br />r <br />� <br />� <br />N <br />PubLc Works Permit • � <br />eiao.oeci., 45525 <br />PoGlm Works Fee <br />Toiil Fee S <br />Less AGDt Fee Pnitl S <br />I Ca�— <br />g� g� Balance D�e S � <br />«� N Noo2-3225LD//g3/ <br />In w M O� <br />04 348-3803 <br />co �i� Z�o <br />oc�'F+¢I4 <br />oJ.lt�i)o V <br />ZiP <br />Attach four (4) copies ot plans lor proposed work � Draw. to scaie anA ncte �ha !ollowing as npPlicable: � <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposed structures on the lol <br />• Existing and proposed utilities <br />• Cer,�erline of street <br />• Ir.dicate NorJh <br />• Show any c,roposed gratling changr.s <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Locafion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424-5555. <br />FINAL INSPECT�ON - Date <br />Approved as Constructed <br />�Arle�� PUBLIC WORK� DEPARTMENT <br />3200 Cedar Streel <br />Everetl, WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDGEPAENT OF CONDITIONS <br />W <br />� <br />� / <br />Z <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applic2nl hereby agrees to hold and save harm� <br />less :he City ot Everetl irom any and all claims tor damages. costs. <br />expenses. or causes ol action that may aris= because of installation <br />anA mamtenance ol the improvement or olher righl�oFway use hereto <br />appl�r.� lor and lurther agrees to remove same upon notice from the <br />Cdy ai:d to replace pubhc properry damaged ihereby. <br />-���"' /U ��/j��.� <br />Si nalure of Applicant Date <br />WORY. AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />l80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MA1 BE <br />CANCELLED BY THE CITY UPCN ANY STOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DAVS DURATION. <br />