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Date S/15/95 <br />PUBLIC <br />Print or Type Only <br />y� TO POaTIN� <br />Application Fou� <br />r- <br />WORK� <br />f, <br />0 <br />;- <br />� <br />PF•RMIT <br />r� o 0 <br />o c� � v� <br />�O ( J J n <br />.a aa -r <br />� <br />APR �� 19�6 <br />0 0 � � <br />�M ;P C1 C� <br />«� «, _. .,, <br />:r: w <br />PuOLc WadS Permit r -�� ,�_n / <br />a�aa oeo� . �%23-5 <br />PUELc Works Fee 5 <br />Tolal Fee <br />gless AOC�� Fee Pa�C S__ � <br />�3�. h�2eoue 5 2 33` <br />Everett Clinic <br />Applicant Mzilmg Address City Zip Phone <br />Describe Proposed Work D4'ID4I.� t10[1 of existi� structures, removal of walks and retainin.e caall,_ <br />construction of curb,�urrar anr� c;�la��alk along 39th Street. Construction of a 31-stall <br />staff oarkine lot and enclosed_dump�ter �rea installation of a storm drainaQe svstem � <br />and installation uf <br />Prolect Address (if known) <br />AUach four 14) copies of plans lor proposed work - Drav� to scale and note Ihe lollowing as applicable: <br />• Pr�perry� Lines <br />• Outline and dimensions of all existin9 and <br />proposed structures on ihe lot <br />• Existing and p�oposed u�ilitie5 <br />• Centerline ol streei <br />• Indicate North <br />• Show any proposed grading changes <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 pedormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� �()�,� 7Z� � f�/12 �r' �'�(J�p/brde��n�t.7 <br />n <br />C/[C/�'c C� /��/� / S C` /!//G On�.�/ — CCJP[/ �[i/ac/JiLCL� <br />/ <br />,� �j/If/ !/SZ a� fLE �-ci O� 67�' 39��57•`' �r �he <br />��i�osP o�' �t.. d(/h-,�t�r�'cCy��i� <br />/S �hO�i6ifcr/ L�nLesS 2L/� priZ�� <br />T fC� /9 E: �t _ <br />�, � rG�visFol <br />�Lai���ny <br />� �1.:� Pcrn,�sl.v� <br />OW/kr TU klOrtE <br />/COM�f7�'D✓` 4rc��. <br />//! G1 CCU�nIe LJ/f�� <br />W <br />� <br />� <br />N <br />� <br />O <br />LQnds���,o��� is' r����:-�d f�� L_ <br />G��Pah7�i.-�cn� a��nova.C, <br />�iroM 2C�,/�+[-�nf propl/fj/ qCKNOWLEDGEMENTOFCONDRIONS <br />0�7 /'.�'!Y%�l'.iidC :^oG.CPrf/. <br />The undersigned owner/applicant hereby agrees to hold and saee harm� <br />less Ihe Citv ol Everett irom any and all claims for damages, costs, <br />� expenses, or causes ol action ihat may arisa because ol installalion <br />�1 and maintenance ol the improvement or other right-obway use herelo <br />applied for and further agrees �o remove same upon notice L•om Ihe <br />�a�e City and to replace public properry damaged thereby. <br />/ /U <br />Hpproved as Consiructed <br />PUBLIC WORKS DEPARTMENT <br />3200 CedarStreet <br />Evered, WA 98201 <br />Phone:259�8B10 <br />� <br />��� - �/ ) w : ,'1 % / " %' <br />igna r� p li ant Dale <br />WORK AUYH RI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY'URSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WONK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />