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3�- T� p��T�hir Date ..y_ <br />Application For <br />PUBLIC'WORKS PERMIT <br />U <br />Print or Type Only <br />b' CD <br />b; <br />ClO U LA <br />Cl o rn <br />U <br />n <br />O O <br />C' <br />0 0 t 0 <br />O <br />d , <br />;Irian & Brent Olson <br />6928-Evergreen <br />Way <br />Everett <br />Public Works Permit <br />Bldg. Dept. is 35814 <br />Public Works Fee <br />Total Fee $ <br />Less Appl, Fee Paid $ /�-- <br />oO -� ' . L eaience Due S <br />O �r <br />Ur C` t + Cli <br />t M CJ <br />98203` <br />353-4533 <br />Owner ^ ,.Maikgg.Add,ress City ?� Zip Phone <br />1 J ft <br />f f . - Cl L• 1 O Lr l � - , I <br />�` f. 4-U 1ila- 4: <br />Lgkeman Arch. #400 1602 H3Wit 'ive Everett 9$ 0-*r^r,•+r.) 259-3161 <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work Construct ne.0 restalurAnt(Alf}, s) <br />Project Address (if known) <br />- 19th Ave BE <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 />0 Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. in advance - phone 259-8810. <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. Cell Location Unde- round Service 48 hrs. before you dig. TOLL FREE NUMBER 1 •B00-424.5555. <br />& <br />rz�,�oncuc�mz S-/9-92 �� CIL P�,dewc�c2�i cL�L�ct/ii<ci <br />IZA_ <br />ate <br />W <br />H <br />Im <br />0 <br />01 <br />z <br />0 <br />0 <br />am <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and m f the improvement or other right-of-way use hereto <br />ied for and fu her agrees to remove same upon notice from the <br />City and to repla puyic property damaged thereby. <br />FI LL SPECTION tte r Date <br />Approved as Constructed nature Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />A� PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259-8810 PROJECT OVER 90 DAYS DURATION. <br />