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a <br />y�e �/zs/9s <br />T4 POSTIldG _ � -.« �� <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only � <br />SCOTT WORLDWIDE 2G00 FEDERAL'AVE EVCRETT 98201 <br />naa�iin.; nr.drebs' . ' ' �.�- <br />KEITH GUNDERSEN 252-5888, <br />Applicant P,!.�dm:; ilttdr:�ss <br />Describe Pioposrd 6Vork <br />i �.'. <br />��.� � �:� <br />GI': <br />� <br />9 <br />'Pubbc C/awn Pnim�l • / � `)'S'S <br />ni,�n Deo� • 4903 <br />Pe1�br.WorxlFo� � -----'.. <br />lot.�l Fpr 5 <br />Ll`55 4ppi irv. �:u�,f 5 <br />ea�rnn, o��.,� 5 J��nS� <br />259-7333 <br />ZIP --' ' <br />-------- - ----- <br />Prolect Address Id kn���vn! �(J,�=�Q �w�� _ ��G.--- -- — __-- _ ---- <br />A�tach lour 1�I copies of plin, loi pioPosed wo:� � D�ac. t:� .r.u...c,.i n,�t,, m,,'�ilo�.vmg as aophcab��� <br />• P�operty Lines • C�•nterlin� ot Sireei <br />• Outline and Aimensions ol all existmq and • Icdicab: Nnrih <br />proPosed structures on �he loi • c„o�: any ::roposerf quu!.nn r^.a��,.u.., <br />• Eristing and proposed utilities • Sha�,� m,�asivements <br />Phnn.—__—___ _ _ _ <br />UV NUI WNIIE iiELOW THIS LINE <br />PEflM1T CONDITIONS <br />1. All calls for inspection sha�l be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be peAormed in �r.cordance with this permit and current City of Eve�ett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-$00-424-5555. <br />�; Ci �:C t�o.-.� �o ,/x �one P,er PL��r� ctPPro�ed <br />�f/ P�.GI.� cdor,Es on 9-/-9s (�oPya1/��Jed) <br />Approved as Constructed <br />��NUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everett, WA 98201 <br />Phonc:259-BB10 <br />W <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />ACKNOIVLECG[��.!EN i OF CONDITIONS <br />i hr. ��nhni.iqnetl ot:neN.IPPbC;inl !:i�reUY �9��e5 i0 h01d dntl Sace h:nnr <br />, i�•ss the Ctly ot Everelt from any and alI daims lor damanc: ;.osis <br />:�'*Penses. or causes of action that may an5= becnuse ol ms';d�anor <br />ind mamtenaor.e M tne improvement or other nght-pl-way us� ���•�rtn <br />� ar.n�:ed tor .lnd luriher agrees m remove sam� UpOn nOtiCe I�nm Ih�• <br />' Civ a�u: tn rrplaca pubLc proner,y Jamaged thereby. <br />' 9 4 <br />� _ <br />u, e ol ApPhcan! Date <br />RK AUiHORIZED BY THIS PERMIT MUST BE STAfiTED �YITHIN <br />190 DFYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />I 0E DILIGENTLV PURSUED TO COP.�PLETION THIS PER611T I.fAV BE <br />CA"JCELLED BY THE CITY UPON i�NY STOPF4GE OF WORK ON 1HIS <br />I PFO.iECT OVER 90 DAVS DURATION. <br />