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Date 3 Z 9Z Pu�bcWor��Permni _L4 ��D / <br /> Applicatlon For eao o,m... 35811 <br /> PUBLIC WORKS PERMIT '°°ro,:FeeFee s _ <br /> �m��oo�Fee PaiU S <br /> Print or Type nnly o��.��ao�s s_�S�—" <br /> oo� -.3z zYoi�g3/ <br /> anain� rn PO Box. 3707 M/S OF-76 Seattle. WA 98124 342-5878 <br /> Owner Malling Address Cdy Zip Phone <br /> Owner <br /> Applicant MailingAddres; City Zip Phone <br /> DescrlbeProposedWork _ naAitir.n *n nM11er b„ilpi.,9 <br /> W <br /> Prolect�ddress lit known� 3003 W. Casino Rd. - Bld . 40-60 � <br /> Attach four(4)copies of plans lor proposed work- Draw lo scale and nofe Ihe lollowing as appllcable: � <br /> • Property Lines • Centodine M slreet � <br /> • Oudlno and dimenaions of ell exisfing an] • Indicale North <br /> proposad struclurea on the lot • Show any proposod grading changos <br /> • ExiSting and Uroposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1.All calle lor Inapectlon shall be mede 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shell be peAormod In acwrdance wilh this permit and current Ciry�if Everett Design end Construction <br /> Standnrds and Specllicatlons. <br /> 3.Call Locetion Underground Service 4B hra.beforo ycu dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> � o��Cvor��t2/c�-„t� re�a�o�-�e�»,,, .�-�7-S'z �oP l O <br /> ciCsuo/ <br /> � <br /> ,� � � <br /> rl � _ � _� � <br /> I I `� `", n-. �_'� �- � . <br /> U "''' , ,0�°L�. 0 <br /> n. .. • .. �., � <br /> � _ _ a <br /> ..`irr oE c -�:� � r <br /> e�.,�i�+i�� :_.__ . <br /> ACKNOWLEDGEMENT OF CONDII"iONS <br /> The undersiyned owner/applicenl hereby agrees lo hold and aeve harm� <br /> � � less the City of Evero�l frum any and ell claims lor damages, cosls. <br /> /��� 7/�Z expenses, o� causes ol action Ihat may arise because of installetlon <br /> i � and maintenance of ihe improvemant m other dghbobway use hereto <br /> � applied for and lurther agrecs to remove samo upon notice Irom Ilie <br /> Approv d1D�Consh ction / �e Cily and to replace ublic properly dameged ihereby. <br /> � i.. �_. ��,/ .. 1 � _ i �.L-� <br /> . ,j v` , <br /> FINAL INSPEC IOlI Dcte <br /> Approved as Construcled Sign re ol Applicant Dete <br /> � PUBLICWORKS�EPARTMtNT WORK AUTHORIZED BV THIS PERAIIT MUST DE STARTED WITHIN <br /> 3200CedarStreet 1B0 OAYS OF [IATE PERMIT IS ISSUED AND THEREAFTER 13 TO <br /> Everett,WA90201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMiT MAY BE <br /> Phone:259-BB10 CANCELLED 8V THE CITY U�ON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 OAYS DUFATION. <br /> � <br /> V <br />