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Date 12-28-93 <br />Application For <br />PUBLIC WORK� <br />Print or Type Only <br />Taco Bell 597 Industry Dr Tti <br />>< <br />� TO POSTING. <br />�ERMIT <br />C:� <br />O <br />L tll� � O� <br />� M� N Ql`� <br />N CU W �.l .-i L� <br />C� � � � al <br />C.1 .ti M <br />Ny. 1 3 2W I I Gublic Worke Perm11 � �/ <br />— eiee� oeoi.s <br />I PubhcWorksFee <br />Toial Fae $ <br />� O � � Less Ao�� Fee Paitl S��1 <br />O �� h Balance Due S �� 4—/� � � <br />O O If) O <br />L� N CJ m <br />tll r'� � <br />N M W <br />ier Mailing Addr p_� o cv � o a ��' ��7i <br />U OOUJ o � ��o <br />.\Y� � CJiIO?st�.'d C�iO�3 <br />Brown Connally Rowan Arch 22�'E 26th Tacoma 984,''^1 <br />licant Mailing Address City <br />Descri6e Proposed Work <br />Prolect Address (it known) <br />[W ti V <br />206 627-4367 <br />Zip <br />Attach lour (4) copies of plans for proposed work • Draw to scale and note Ihe following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lol <br />• Existing and proposed utili�ies <br />• Centerline of street <br />• Indicate North <br />• Show any proposed 9rading changes <br />� Show measuremenis <br />Phone <br />Phone <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 wilh this permit and current City of Everett Design and Construction <br />Slandards and Specifications. <br />:i. Call Location Underground Service 48 hrs. before you dig.70LL FREE NUMBER 1-800•424-5555. <br />� ��- ��,ti.���e�s �Q� 3-3,�-9� <br />PLBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everelt, WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />F- <br />� <br />� <br />O <br />H <br />� <br />O <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less Ihe City of Everell Irom any and all claims for damages, costs. <br />ezpenses, or causes of 2ction that may arise because of installation <br />and maintenance of the improvement or other right�of•way use here�o <br />applied for and further agrees to remove same upon notice from the <br />City and ro replace blic properry damaged thereby. / <br />i <br />Signature o plicant Date <br />WORK AU RIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMFLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPF.IGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />