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�a�e 11�i�OQ PuEhcWmM�Permil• <br /> B�Ep.D�D��• 3BSBB <br /> Applicetion For <br /> PUBLIC WORKS PERMIT PueTot�F:;`°. . <br /> Ln��oP�Poe PHE / <br /> B�I�nuUue / <br /> Print or Type Only <br /> • <br /> BoB1714 � PO BOx 3707 M/S OF 76 Caattla WA OHlld - - 'id7-747A <br /> Owner Melling Addreas Cily Zip Phone <br /> Ownnr — <br /> Appllcant Mailing Address CItY Zip Phone <br /> Deecribe Proposed Work Construct new buildinq (enginaerinq test facility) _ <br /> W <br /> Prolec�Address(fl Anown) 3003 W. Caeino tid. - 40-41 � <br /> Attach four(4)copiee of plane tor proposed work- Draw to acale and note Ihe tollowin{ as applicable: � <br /> • Property Linea • Centerline ol atreet � <br /> • Outline end dimensiona ol all exieting and � Show eny proposed grading chanqes <br /> proposed slructurea on Ihe lot <br /> • Ezleling and proposed utilitles � Show measuremenla M <br /> W <br /> N WRI BEL W HIS LINE O <br /> PERMIT CONDITIONS � <br /> t.A��cNle lor inepectlon ana��be made 24 hre.�n edvence•pnone 26�8810. <br /> 2.All work ehell be peAormed In eccordence wlth thia permit end curtenl Clty of Everett DeaIB�end Conetructlon <br /> Btendards and 3pecificetlona. � <br /> 3.Call Locatlon Underqround 9ervice 4B hre.before you dlg.TOLL FREE NUMSE111•800�424665b. <br /> O <br /> PUBLIC WOHKS PERMIT � <br /> BY NO�UIRE� E— A�,fF�qOf/ZJSUEO /w <br /> r♦ <br /> DATE y O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applitant hereby agreea to hold and 6eve herm� <br /> less Ihe Cily ol Everell Irom any and ell claims lor demage& cos16. <br /> eaDenses, or teuses of action �hel may erlse betause of instelle�lon <br /> end meinlenance ol the improvement or olher right•ol•way uae hereto <br /> appl�ed lor and lurther aB�ees to remove seme upon nolice Irom the <br /> Approved for Conetruclion Dete City and lo replace public property demeqed thereby. <br /> FINAI INSPECTION Date Date <br /> Appro�ed as Constructed Signature of Applicant <br /> WORK AUTHORiZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � PUBLICWORKSDEPARTMENT 180 OAYS OF DATE PERMIT IS ISSUED AND THEHEAFTER IS TO <br /> 3200CedarStreet BE DILIGENiL'I PURSUED TU COMPLcTION. THIS PERMIT MAV BE <br /> EveretL WA 98201 CANCELLED BY THE CITY UPON ANY STCNPAGE Of WORK ON THIS <br /> Phone:268•8810 PROJECT OVER 90 DAYS DURATION. <br />