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Date <br /> 1/6/92 Pubbc War��FermO• _. <br /> Blap Depl . 9z�3525� <br /> Applfcatlon For <br /> PUBLIC WORKS PERMIT °°°"`"`°,".`.. <br /> Totel Fee 8 <br /> Leu�ppl Fee PUE � <br /> Baie�ce Due 6 <br /> Print or Type Only � <br /> Soein4 CA PO Box 3707 M� n vg c r*i � wn oat�e 342-5878 <br /> Owner Malling Address Ciry Zip Phone <br /> owner <br /> Applicant Mailing Addreas Cily Zip Phone <br /> DescribePropoeedWork �nstruct 120 OOOsf a�rcraft asxe hly h il.�iny <br /> W <br /> Prolecl Address(if known) � � <br /> Attach lour(4)coploe of p�ans lor proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Llnes • Centerllne ol sireet � <br /> • Outline nnd dimen�ions of ell azlsting enA • Indicate North <br /> propoaed at�uctures on the lol • Show eny proposetl grading chenges <br /> � Existing and proposad ulilillea • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells lor inapectlon she�l be made 24 hrs.In advance•phone 259•8810. � <br /> 2.All work ahell be peAormed in eccordence with this permit and current City ol Everett Deslgn end Conelruction <br /> Standerds end Speclllcatlona. - <br /> 3.Cell Locatlon Underground Servlce 48 hra belore you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> ��yya.vT 4.!/Lc..:.� ..�/�'�' � Z/4i, �Jl�.;�'� O <br /> C� � <br /> ��,y .��. <br /> ��C.`�LC/ L✓ !/— C <br /> /(� � <br /> /,�7%� O <br /> a <br /> ACKNOWLEDC�EMENT OF CCNDITIONS <br /> The undersigned ownor/applicant hereby agri:es to hold and save harm- <br /> less Ihe City ol Everett Irom any and a11 caims for demeBes, casls. <br /> ezpenses, or causes of action that may ari3e beceuse ol Instaltetion <br /> and r,iain�enance of the improvemenl or olYer right-ol-way use hare�o <br /> epplied lor and furiher agrees to remove sime upon notice Irom the <br /> Approved lor Conslructlon Dete Cily and to rep�ace public property damegec Iheroby. <br /> FINAL INSPECTION �a�O - Dete <br /> Approved as Conslruc�ed Signature ol Applicanl <br /> � WORK AUTHORIZED BY THIS PERMIT �°,UST BE STARTED WITHIN <br /> PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PFRMIT IS ISSUEC AND THEREAFTER IS TO <br /> 3200 Cetler Siree� BE DILIGENTLY PURSUED TO COMPLE'ION.THIS PEHMIT MAY BE <br /> Everett,WA A8201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />� Phone:259�0010 pROJECT OVFR 90 DAYS DURATION. <br />