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, , <br /> 9NI1SOd Ol � <br /> � APPlication For .,� I <br /> PUBLIC WORKS PERM(T Date 6-18-98 <br /> PUBLI�WORKS DEPARTMENT �i Public Works Permit# _ � � � <br /> 3200 CedarStreet !,LI <br /> Everett,WA 98201 259-8810 t� Buildin Permit N_59189 <br /> '+� of1STING �I1L 19 1999 ��; s <br /> 00 <br /> iYPE OR PP.IVT ONLY Public';Yorks Fee$ �S <br /> n - <br /> , ;'1 <br /> , '- r., <br /> PORT OF EVERETT PO BOX 538� EV�RETiT �36206' i 259-3161 <br /> Owner Mailing Address " "Ciiy Zip Phone <br /> �. - <br /> OWNER � ' <br /> ill �[� L <br /> Applicant Mailing Address:; '�, ;,; - � '-� G�Y ZiP Phone <br /> . :.f. u o) ��`i '.. -. .._ _. _� f'-� <br /> Describe Proposed Work NEW BLDG FOR RESTROOM S LAUNDRY � <br /> � <br /> v/ <br /> PROJFCT ADDRESS(if known) _�20 — I3—�' Sf � <br /> Attach four(4)copies of plans for proposed work-Draw to scale and nota the following if applicable: <br /> 'Property Lines •Oulline ar.d dimensions of all exisling and proposed structures cn ihe lot •Existing and proposed utilities O <br /> 'Centerline of streel •Indicate North •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1. AII calls for inspection shall be made 24 hours in advance -phone 259-8810. O <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBEk 1-800-424-5555. ` <br /> �� q 1 �1—/► <br /> � !/r/t°Jp't�" C D �e �C�hc �De r` �O �4�� V♦ <br /> �p�h��-�o� d,� ,-,�- 9e �eo�y e r`f�/,e o� O <br /> � a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � � O The undersigned owner/applicant hereby agrees lo hold and save harmless <br /> � / B the City of Everett from any and all claims for damages,costs,expenses,or <br /> A oved for nstructi � Dat ' ccuses of action that may arise because of installation and maintenance of <br /> the improvement or other right-of-way use hereto applied for and i�rther agrees <br /> � to remove same upon notice from the City and ro replace puLlic property <br /> �—- �p _�7-�� d�maged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed <br /> Signslure tApplicant Date <br /> IWORK A�ITHORIZEO BY THIS PERMIT MUST BE STARTED WITHIN 780 DAYS OF DA'I E PERMR I ISSUED AND THEREAF7ER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANC:LLED BY THE CIN UPON ANY STOPFAGE OF N.iORK ON THIS PROJECT OV[R 90 DAYS DURATION. <br />