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TYPE OR PRINT O�:LY <br />itbn For <br />PUBLIC W RKS PERMIT <br />PUBUC WORKS DEPAR7MENT <br />3200 Cedar Stroet <br />Everett, WA 98201 259-8810 <br />� / <br />Oste <br />PubNc Works PertnH • <br />Buildirg P�nNt 1 _ <br />Publfc Worke Fee S _ <br />Plan Check Nos H 57202 SEPI� <br />11pplicat.Date: 11 21 97 <br />Owner Job Addreee: 32 8 OCK8F8LLHR AVS <br />Ownar: RIDEA DON <br />Tanant: <br />Propo�ad Us�s 4—PLSX <br />Applicant <br />Describe Proposed Work _ <br />PROJECT ADDRESS (if known) <br />D��c. of Work: <br />Cl1RPOAT FOR FOUR CAR P71R1f8 <br />OFFICB SET JOB S6T ' <br />1►PPAOVED FOR PERMITt Dl►TS_/_/_ <br />Phone <br />Pho�e <br />Ariach lour (4) copies of pkns tor proposed work - Draw to scale and note the Iolbwiny N applkable: <br />•Proparty Lines 'Outline and dimenslons ol all exlsting end proposed structuroa on tha bt `Exlsting and propoaed utilttbs <br />•Centerline ol street •Indleeta North 5trow eny proposed greding changea 51ww measurements <br />PERMIT CONDITIONS: <br />1. All calls foi inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City oi Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dfg. TOLL FREE NUMBER 1-800-424b55S. <br />�u� ��prWR UUIN6 �,-. <br />)Y_�� l2/ �� <br />�ATF . ----��/"'�'. <br />( <br />Approved for Construdion Dale <br />FINF,L INSPECTION Date <br />Approved as Constructed <br />� <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownar; applicant heraby prees to hold end sevs hartnless <br />the City of Evereri trom any and all claims tor damages, cosb, axpsnses, or <br />causes o1 actbn that may adse because o1 Instetlatbn end mWdenanoe af <br />the improvement a other rlght-ot-wey use hereto applbd tor and NAAer a9ree$ <br />to remove aame upon notice fiom the CNy end to roplacs puWie WopshY <br />damaged tM�eby <br />Signaturc of Applkant at� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WiTHIN 180 DAYS OF DATE PERMR IS �SSUED AND THERE4FTtR IS TO BE DILIGENTLY PURSUEO TO <br />COMPLEf10N. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS WRATION. <br />