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Date 8-11-92 <br />TO WTING 5 - <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Works Permit • 9a .� o �- <br />alduDePt• 37676 <br />Public Works Fee <br />Total Fee S _ <br />Less APPI. Fee Paid S <br />alliance Due <br />oat-3uSy^3i�83i -. /A�" <br />Port of Everett PO Sox 538 Everett 98206 259-3164c�-jc2Yc/--� <br />Owner Mailing Address <br />City Zip Phon� <br />Owner Mike McCollough <br />Describe Proposed Work <br />Mailing Address <br />TI in chill facili <br />ty Z'P Phone <br />— 7G�ol <br />Project Address (if known) -2928- Terminal Ave - pier LU <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street _ <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS O <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-881 O. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrsbefore you dig. TOLL FREE NUMBER 1.800-424.5555. <br />4 dL G. IS,�-S2ciCr c no�ei nurfl-eti� O <br />�l Tion /'h t/St 6e {"gill Sc r <br />�r-- U/9, FOrm �/✓M6,n Carr. <br />S, Caftii 64S/ns Jlra'C de 16 <br />#GONE 6-ell d �oZ Sup c� f �e t„s7` �0 y C,�eyy S mo�eaol V♦ <br />O <br />a <br />w <br />Approved fol Gonstructlonon Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />CLPUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm. <br />less the City of E.arett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City 5ijif to lace public property damaged thereby. <br />alynat�e of Applicant l 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 PURSUED 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 />