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Date Z�19�86 • <br /> Public Warks Permil• <br /> Bi48 Dept♦ <br /> Application For reet <br /> PUBLIC WORKS PERMIT 86,,�n�� <br /> Pu01ic Worka Fee s <br /> Totel Fce <br /> Less Appl iee Pa1E S <br /> 0alance Due S <br /> Print or Type Only <br /> 0'Day Heating Co. inc. 3211 Smith Street Everett 98201 259-2126 <br /> Owner Mailing ndd�ess CYy Zip Fhone <br /> Ayer Construction Co. Inc. 6525 Beverly Blvd. Everett 98203 353-6427 <br /> Applicant Mailing Address City Zip Phone <br /> Place Office Trailer beside existing building at 3211 Smith <br /> Describe Proposed Work <br /> - W <br /> Project Address(if known) _ 3211 Smith Street � <br /> Aflach lour(4)copies ol plans for proposed work- Oraw to scale and note Ihe following as applicable: � <br /> • Property Lines • Centerline ot slreet � <br /> • Outline and dimensions of all existin9 and • Indicate Norih <br /> proposed slruclures on ihe lot • Show any proposed grading changes <br /> • Exisling and proposed ulilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls tor inspection shall be made 2� hrs. in advance- phone 259•88�5. � <br /> 2. All work shall be perlormed in accordance wilh ihis permit and current City of Everetl Design and Construction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER �-800•424•5555. � <br /> /�L�GL�G' G�L-'_r,./.'.t`�-' /-�-��'��?,T �L'Oi /'cFC�cv�"C—"/J O <br /> / /.G'.�/ �/l, /�b <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe Ciry of Everell Irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance ol ihe improvement or other right-ol-way use hereto <br /> applied for and further agrees to remove same upon notice irom the <br /> Approved lor Consiruction Date Ciry and to replace public property damaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Cons�ruc�ed Signature ol Applicant Da�e <br /> everett PUBLIC WORKS DEP�RTMENT WORK AUTHORIZED BY 7HIS PEHMIT MUST BE STARTE� WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEfi IS TO <br /> � 3200 Cedai Street BE DIIIGENTLY PURSUED TO COMPLETION. TIiIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 pROJECT OVER 90 DAYS DURATION. <br />