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Date.•;^a-22-95 <br />Application Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Port of Everett PO Box 538 Everett WA <br />Address <br />a�y <br />259-3764 <br />q�WK Work� ►nmM • / � / <br />e�ao o.o�. • 48654 <br />P�ol¢WMaFea = <br />Tol�l Fee <br />��y Appl Fee V��O s�—�-- <br />�� <br />B�bnceDue s __ <br />Judd Luton 4529 127eh St NE Naryeville 98271 658-1647 <br />Applicant <br />Mailing Address City ZiP Phone <br />Descrlbe Proposed Work drive-thru eepreseo etand <br />Project Address li� knownl 91� W <br />Atlwch lour 141 CODiBS O� pIBnS for pto0�S0d wO�k - DfalN• ID 5r.e19 antl note tne loilowmg as apu�icable�. <br />• Property Lines <br />• Outline antl dimensions ol all exiSUng and <br />proposed structures on the lol <br />• Existing and proposed utilities <br />• Centerline of street <br />• Intlicale North <br />• Show any proposed gfading changr.s <br />• Show measurements <br />PERMIT CONDITIONS <br />i. All calls for inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. All work ehall be peAormed in accordance with lhis permit and cunent City of Everett Desiqn and Conatn�ction <br />Standerds and Specificetiona <br />3. Call Locatlon Underground Service 48 hra before you dig. TOLL FREE NUAABER 1-800�424�5555. <br />� �`ri,r,��ey 4ccers <br />•'�r�de� sfi.�l� .6� <br />C0�7SfYVGf'�-�n <br />fei.+Po r.. . y. <br />i <br />D/1t�'p /!l�tr�ine V�W <br />�■�.� P��...... � ..r� <br />_Sfi�ecf Zi���vr/trheotr �„o/ access SLi�LI � <br />CfJ��sti^v�ftci in �'vn���ct;`a., t✓.f/, fhe PD�eT <br />C� Ever�>f` sf•rec�` /i.,pro✓en�an-� P�-a,jeC7� <br />%iLL Oh/✓irq Sui^("'Q [e f, 4 n 0� �F r,E/�+y � Ct S� � a�L <br />� Be Pav¢d u�;7�� /��n, a�' 2''c� Cftst 6 41'P�al7; <br />(p, T�e c✓: o��� of �'/, e pr:vaw�y enf�-ak¢et -S'halL �e <br />Li�„ i�d fo Z'f u�iLzss a.PP.'a•ed bS/ �rcr,ow�Eo� �� o coNoiTioN�er, <br />tor <br />FINAL INSPEGTION <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everetl, WA 98201 <br />Phone: 259•8810 <br />____ --- <br />�.� !`�s � <br />Date i <br />>> -9'� � <br />Date I <br />� <br />� <br />O <br />a <br />The undersigned ownedapplicant hereby agrees to hold and save harm- <br />iess the City of Everett trom any ana all claims for damages. costs. <br />ezpenses. or causes of action that may arise because of installetion <br />anA mamtenance of the improvement or other righ�•ohway use hereto <br />app��ed ior and lurther agrees t0 femove 58me Upon nofice from thB <br />C�;y ,�nd to replace pubOc property damaged thereby. <br />7ure ot ApDllcant Date <br />RK AUTHORIZED BY THIS PERMIT MUST BE STARTEA WITHIN <br />t80 DAVS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />