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Date_ 1 6-95 <br />Applicalion For <br />PUBLIC WORKS <br />Print or Type Only <br />pwner <br />.v. CI 7 Z 7— / <br />ac I <br />� Public Works Perm11 • <br />"' LF,hfiR <br />eiea oePi. � <br />�ERMIT <br />� <br />0 <br />0 <br />� ovaiQuv`�i <br />a <br />� aa�� <br />N... <br />\�'-a� -r�,w <br />���o� <br />Public Wo�ks Fee $ —_ <br />To�e� Fea <br />Less ApO�� Fea Peid § --�—�— <br />$ 3s�_ <br />Balance Oue <br />DVG" �44%��/L7�/ <br />Zip <br />Ciry CiP ..." <br />Describe Proposed work drive thru espresso (Compact Coffee Co) <br />Proiect Address (if known) <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following aa applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed stnictures on the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate Norlh <br />• Show any proposed 9rading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 O. <br />2. Ail work shall be performed in accordance with this permil and current Cily of Everett Design and Conslruction <br />Slandards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•S00•424•555 . <br />/; <br />U%'Y l�C�w 2 `J <br />Cc �n �r� S�`� L <br />/ �` 1/� � ( <br />Zi.� �r�t hCE /'J,�v� fJ¢ �a �ed� /� <br />pT �l � /�S7 S%l�nC7' %✓iUl� 4�10 <br />- ��> CL�rJ <br />/�'i� n, �'+ ` <br />--- - __n _. — ., <br />�,�G 1 lr a `d/h`)ttC r C�%1i�P e <br />bas,H�is 1�a� been remc,n�r� <br />Rr,,.� s i � P • <br />PUBLIC WORKS DEPARTMENT <br />3200 CedarSheet <br />Everett, WA 98201 <br />Phone:259-8810 <br />��' �cs'Pl � L Z�' <br />� (CPS S <br />� <br />O <br />H <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Cily of Everell trom any and all claims tor damages, costs, <br />expenses, or causes o( action that may arise because ot installation <br />and mnintenance of the improvement or other right-of-way use hereto <br />applied �or and further agreesefo �damaeed herebyn �otice from the <br />City and ro replace public prop Y 9 <br />;/ � B ,.�r,� �- � s� <br />�"'� � Date <br />Signa re of APPlicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />BE DI�LIGENOTLY�PUR UED TOICOMPLE�TION.DTH SEPERMIT MAY BE <br />I PROJECT OVER 90 DAYS DURATION. STOPPAGE OF WORK ON THIS <br />