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Date 9-5-91 <br /> Puplic Worka?ermrt• <br /> Application For Biao oeo� • 91/27642 <br /> PUBLIC WORKS PERMIT P�����W�.�.Fea <br /> Totel Fee s <br /> Lees�opl Fee Paid f <br /> Print orType Only Balance0ue f <br /> � RosTING �� <br /> Dwayne Lane 828 Grand Everett 98201 <br /> Owner Mailing Atldress Clty Zip Phone <br /> Dykeman Architects 400 First Natnl Bk Bldg Everett 98201 259-3161 <br /> Applicanl Mailing Address City Zip Phone <br /> Describe Proposed Work '180 SF CMU Bldq <br /> Project Address�il known� 2901 Rucker Ave � <br /> Attach lour(4)copies of plans for propose0 work- Draw to scale and note the following as applicable: � <br /> • Property Lines � <br /> • Centeiline of street � <br /> • Outline and dimensions of ell existing and • Indicate Norih <br /> proposeA structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls for inepection ahall be meda 24 hrs.in advance•phone h59•8870. <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everatt Design and Construction ' <br /> Stai}derde and Speciticetions. <br /> 3.Call Location Underground Servicr 48 hrs.befor=you dig.TOLI FREE NUMBEq�-�-4z4•Sb55. <br /> ���- �a�1, � � Z <br /> � ��� .�u..��v � <br /> ,�g �.. <br /> _o/ �A <br /> 9�� � v� <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims Ic� damages, costs. <br /> expenses, or causes ol action ihat may arise because ot installation <br /> and maintenance of the improvement or other righFol�way use hereto <br /> Approved for Consiruction pa1e applied lo� and further agrees to remove same upon notice from Ihe <br /> City and to�eplace public property damageA thereby. <br /> FINAL INSPECTION Dale <br /> Approved as Con�trudetl Signature o!ApPlicent Date <br /> � PUBLIC WOHKS DEPARTMENT WORK AUTHORI7_ED BV THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CetlarStreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS TO <br /> Everett,WA gB201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PFRMIT MAY BE <br /> Phone:259-8810 CANCELLED �V TH£CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PNOJFCT Ob'ER 90 DAYS DURATION. <br />