Laserfiche WebLink
Date°�14/85 <br />Appiication For <br />PUBLIC WORKS PERlIIIIT <br />Print or Type Only <br />Public Worka Parmit ♦ �J _� /�� <br />BICg. Dept • 85/14989 <br />Public Works Fee <br />Talal Fea $ <br />Lesa A�pt Fee Paitl $ <br />Baience �ue 3 /:�� Cf/G.C'l>E <br />�.9CdiflCE OF �c7 ic;e�a�T <br />Larry O. Hillis 620 S.E. Everett Mall Way Evere�EEf ��v5013`/�Q//, <br />Owner Mailing qddress �ry <br />Y Z�P Phone <br />Same <br />Applicant <br />Describe Proposed Work <br />Mailing Address <br />Construct i'estaurant Building <br />Project Address (if known) 620 S.E. Everett Mall Way <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centedine of sireet <br />• Outline and dimensions of all existing and • Irdicate North <br />proposed structures on the lot . • Show any proposed grading changes <br />• Existing and proposed utilities • Sliow measurements <br />PERMIT CONDITIONS <br />Phone <br />1. All call5 for inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Desigi and Construction <br />Standards and Specifications <br />3. C211 Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•$00•424-5555. <br />c�( D,..>. i �n�lrs j/J�f�.LOi/E/�9Eit/}^� %O !3� <br />�� s/TE � <br />�O/lJSi2I/C'TF_ .D t-�E:C� A/�i��DYEU � dN5 j,.0 TF /.'� <br />7-�7 �9s�� <br />s,TE ZMPi2cr E�rC.vTs- � 2 T•s,s P,�-o <br />7�dn�`c uNl�F ' TEci <br />� �E.em i % �'/;/� ., <br />� ��czyi��z� %��s <br />Approved fo Co struction � Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Eve�ett, WA 98201 <br />Phone: 259•887 5 <br />ACKNOWLEDGEMENT OF CONL�ITIONS <br />W <br />� <br />� <br />� <br />� <br />LJ <br />♦�A <br />V♦ <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of ihe improvement m other righbof-way use hereto <br />applied for and further agrees to remove same upon nctice irom the <br />City and to replace public property damaged thereby. <br />� <br />Signature oi Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUR5UED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />