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� <br />l <br />� Application For <br />PUBLIC WORKS PERI!!IIT <br />TYPE OR PRINT ONLY <br />Owner <br />Applicant <br />Describe Proposed Work _ <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257-8810 <br />Plan Check No.: <br />]ob Address: <br />Owner: <br />Tenant: <br />Application Date: <br />Proposed Use: <br />Type of work: <br />89908-008 <br />7903 EVERGREEN WAY <br />S M INVESTMENTS <br />FREDDIES CLUB <br />8/4/99 <br />�ie <br />Public Works Permit q <br />Buildin� ,'ermit k _ <br />Public Works Fee $ _ <br />Phone <br />PI.ACE TEMPORARY MOBIL OFFICE <br />Uffice Se�— Job Set Fire/Planning Set <br />Approved For Permit: Date: _ By: <br />PROJECTADDFiESS (ii known) <br />Attach four (4) copies plans lor proposed work - Draw lo scale und note the followin� If applicable: <br />• Propedy Linzs • Outline and dimensions o( all existing and proposed stmctures on the lol • Existing and proposed ulililies <br />• Centerline of street • Indicate NOAh • Show any proposed grading changes • Show measurei��onts <br />DO NOT WR!TE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257•8810 <br />2. All work shall be pertormed in accordance with ihis permit and current City of Everett Design and <br />Consiruction Standards and Specifications. <br />3. Call Location Underground Seriice 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />INITIAL f��k�;.-_..�;s;,�z <br />PAUL P.iatcE <br />DATE � —� z—� 5 �,i_ <br />''UCUC WpRKS rERddl'r <br />ROT UUIRE� <br />II y.__ <br />4ATE..,_� � �_ <br />- ��. _ <br />pprove or onstrucaon ate <br />FINAL INSPECTION <br />Approved as Constructed <br />Dale <br />W <br />� <br />� <br />Y / <br />� <br />O <br />r— <br />V / <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIOIJS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />Ihe City of Everetl from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installalion and maintenance of the <br />improvement or olher right-ol�way use herelo appiied for and (unher agrees lo <br />remove same upon notice irom ihe Ciry and to replace public property dam- <br />aged thereby. <br />ignat5' ure oiJ�p icant ate <br />WORKAUT110RQED BYTHIS PERMff MUSTBE 5TAHTED'NfTHiN 160 DAYS OF DATE PERMR IS ISSUED ANO THFREAf-ER IS TO DE DIUGENTLY PUflSUED TO <br />COMPLEIION. THIS PERMR MAY 8E CANCELLED BYTHE Cf1V Uf'ONAVY STJPPAGE OF WORK ONTi115 PRQIECTOVEA 90 �AYS DURATION. <br />