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Date 28 92 PUEnc Worxs Pe�mlt• G ���/ <br /> BiCp DeO��• 36858 <br /> AppliCaiion For <br /> - l�UBLIC WORKS PERMIT PuCi�cWoiksFee <br /> Totnl Fee s <br /> Le55 Appl F¢e Peid S <br /> J��J!' <br /> TO POSTING �C/ �2 g' BaianceDue S �� <br /> Print or Type Only q - c_ <br /> ODZ-�'�Z yo/7h�% <br /> Port of Lvere[t POB 538 Everett 98206 259-3164 <br /> Owner Mailing Address City Zip Phone <br /> Don Hamilton 259-3164 <br /> Applicant Mailing Atldress City Zip Phone <br /> Describe Proposed Work Underground fuel tank vault <br /> � <br /> W <br /> P;aiectAddreu�ifknown) �500 Tarminal Av � <br /> Attach four(4)copies of plans for proposed worh- Draw to scale and nol�;ihe following as applir.able: � <br /> • Property Lines • Centerline of street /� <br /> • Outline and dimensions of all ezisting and • Indic2m Norih V� <br /> proposed structures on the lot • Shuv+any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for Inspection�hall bE made 24 hrs.in advance•phone 259•8810. � <br /> 2.AII work shall be performed in accordance with this oermit end current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Cell Location Underground Service 48 hie.before yau dig.TOLL FREE NUMBER 1-800�424•5555. � <br /> � U/�f' CcK�i"Y� lu C7E c%i��� ��'r ���G��S �!"/li�U✓FO� ` O <br /> \ <br /> �9v f7�Glic Cc�,.�r.�S a� 7-b'-�4� <�r��ya/���/� ��� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to holtl and save harm� <br /> less ihe City of Everett Irom any and all claims for damages, costc. <br /> e.pense>, or causes of action ihat may arise because of installaliun <br /> / ) /i and maintenance of the improvement or other right•obway use hereto <br /> �l'G �-f'�— � applied lor and further agrees b remove same upon nolice irom the <br /> Approved br Const fSon Date City a �o replace pu lic pr-pert damaged thereby. <br /> �� _ .�.0 /U- 2 2 -� � �1 ' <br /> FINAl. INSPECTION Date � ' � Date <br /> Approved as Construded Signature ol ppli t <br /> WORK AUTHO I D BY THIS PERMIT MUST BE STARTEU WITHIN <br /> PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200Cer�arFtreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERM1IIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WGRK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAVS DURATION. <br />