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Apnncation For <br />OL PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 25L-8 <br />TO POSTINV41-61 <br />TYPE OR PRINT ONLY <br />Date 11 / <br />Public Works Permit M _ Y <br />Building Permit N._— 940911 e-�f <br />Public Works Fce $ __! Q 6 l / _ <br />DENNIS PETROLEUM 9826 7Tk1 AVE SE EVERETT 98208 353-9701 <br />Owner Mailing Address City Zip Phone <br />_NARY PARKINSON 252-2153 _ <br />Applicant Mailing Address city Zip Phone <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) 1 S1S — f / Z 6 S-,s: S <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following If applicable: <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot 'Existing and proposed utilities <br />•Centerline of street 9ndicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <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 NUMBER 1-SM-424-5555. <br />App _ for o r/ on Date <br />/q/a/S i <br />FINAL INSPE T10N Date <br />Approved as Constructed <br />05/70/97 10:34AM 000014 <br />i <br />N00009360 <br />WATER $1200.00 <br />N90031079 <br />SEWER $70.00 <br />SVSDEV f2612.00 <br />W <br />1- <br />ca <br />O <br />mi <br />z <br />`O <br />i <br />O <br />a <br />tt f <br />BNDIII $1068.219 <br />NOOW9361 <br />WATER $260.00 <br />��#�00t�0p97124l� i �G� <br />ACKNOWLEDtJ61MENT OMIRAE IFIONS <br />The undersigned owner/applicPWA"y agi 9119%ld and save harmless <br />the City of Everett from any anpWJl ens $13r;holl , costs, expenses, or <br />causes of action that may arts;Peer se qA4�, in and malntenanre of <br />the Improvement or other right-o-way use here o app ied for and further agrees <br />to remove same upon notice fro ity and to replace public property <br />damaged thereby. <br />WORK AUTHORIZED BY T14IS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 70 BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />