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Date 1/6/92 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Wodt Permit e <br />Bldo Dept a 42 /5251D <br />Public Wmxa Fee <br />Total Fee <br />Laaa Appl Fee Paid 6 <br />Balance Due S <br />Ac t a r`n vn 22n2 Fa/c OS 76 Seattle WA 98124 342-5878 <br />Owner Mailing Address City Zip Phone <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work Oonst-rnr 1 5 DOnaf airrraft_a gn,hll hnj,ldjng — <br />- <br />W <br />3003 W. Casino Rd. Bldg. 40-35 <br />Project Address lit known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />ttlt� <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • 3how any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />M <br />DO NOT WRITE BELOW THIS LINE <br />O <br />PERMIT CONDITIONS <br />1. All calls for inspection she'. Be made 24 his. in advance - phone 259.8810. <br />2. All work shell be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />z <br />O <br />�89l <br />a <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />lei-sEp__�L PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT Or CONDITIONS <br />The undersigned owner/applicant hereLy agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />