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10/11/94 <br />Date <br />Application For <br />PUBLIC WORKS <br />Print or Type Only <br />Daniel Baggenstos 9924 Emander Rd <br />Owner <br />Don Counsell <br />�E` P�STING -`- <br />T <br />P�;RMIT <br /><T <br />fJ <br />O <br />r:� <br />oocin c� o� <br />r �i o in v� r_� r_, u <br />� i! OI7� U (�v <br />!� M +P t'i C•1 y> .� <br />Eveiet� �8204 �" 35��t98� <br />Mailing Atldreu rn <br />252-1111 Dan Baggens <br />Mailincl <br />Describe Proposed Work � — 8 uRit <br />Project Address (il known) <br />l:riKll O(��� � <br />U O I� f.J W L�'� <br />p 1-b 3UJ <br />�i � z '.�u U) in <br />� <br />Pu06c Works Pmm�t i � � • • <br />B1ap Depi. • 5 OV _ <br />PuEi¢ Warks Fee <br />Total Fee S <br />Less ApO� Fee PaW � <br />Ba{a9�P94g in S � � <br />� t _+ J. =.� <br />1'.• •'( I� '< fy <br />�..� «. n. r- <br />;�r <br />a r <br />i�Ul m IJ � fc� -. <br />� W O IY �+ W !� <br />�h O\ \...lal <br />�r,�,� a'r�-i.2 n�S <br />2ip <br />Attach fow (4) copies of plans lo� proposed work - Draw to scale antl note the following as applicable: <br />• PrOperry Lines <br />• Outline and dimensions ol all existing and <br />propo5ed SiruGlures On Ihe lot <br />• Existing and proposed ufilities <br />• Centerline ol street <br />• Indicale North <br />• Show any proposed grading changes <br />• Show measuremenis <br />rnone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls lor inspectior� :liall 6e made 24 hrs. in advance - phone 259•8810. <br />2. Ail work shall be penormed in acwrdance 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 />�. �i5 �r ��ved �l�cns e+��. 12��1/q¢ <br />Approved as Constructed <br />�Are�� PUBLIC WORKS DEPARTMENT <br />� 3200 Ceoar Street <br />E <br />� Everetl, WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />�w <br />_/ <br />i� <br />• <br />� <br />0 <br />�"' <br />� <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City ol Everet� Iwm any and all claims lor damages, costs, <br />expenses, or causes ot action that may arise because ot installalion <br />, and maintenance of ihe improvement or other righbol-way �se herelo <br />applied lor and turthei agrees to remove same upon notice irom the <br />City to replace public property damaged thereby. _ <br />i � <br />Signatwe ol Applicant Dale <br />WORK AUTHORIZED BY HIS PERMIT MUST BE STARTED WITHIN <br />180 DPYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUFSUED TO COMPLETION. THI� PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />