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ApplicationFor �� �'OSTING �0 ��—� <br /> � PUBLIC WORKS PERMIT oa,e - — ___-''—y� � <br /> PUBLIC WORKS DEPARTMENT Public Works Permit N _�� O ✓ <br /> �9200 Cedar Shaet <br /> Evereft WA 98201 259-8810 Building Permit q, <br /> � s:�, " � ;`' . �50�;2� � � . <br /> TYPE OR PRWT ONLY � c� Y �. c - ;.�- Public Works Fee$� � <br /> ,n o � w c�.� `�' r- r, �.: <br /> ' = :a v� er+ w r-.� r� . <br /> , .-; <br /> w <br /> .;���'. Ci ._ '���r�•.- ;.��c^ 1'41 Rtate A`�e �arv!9v�11e '�A 93G70 E5'<-i%2U '. <br /> Owner Mailing - ress.-.:: r� :,; m . . =, Zip Phone <br /> . �. �� :� .� i �. ,_ <br /> � a i <br /> � . . .__�.:�r� �,i1"�. L•or c� � -�: �3iY � �4,��.!To�} i ; �' � <br /> Applicant Mailing Atldress City Zip Phone <br /> Describe Proposed Wark "�w huuse � <br /> -� <br /> ,�A <br /> V♦ ' <br /> PROJECTADDRESS(ifknown) 'S Aldex S: .ot ].t ,�r,rkside �;r.srt <br /> , Attach four(4)copies of plans for proposed work-Draw to scale and note the following if applicable: � ' <br /> �. �Property Lines 'Outline and dimensions of all existing and proposed structures on the bt •Existing and proposed utilities O ., <br /> �, 'Centedine of street •Indicate Norih •Show any proposetl grading changes •Show measurements � �� <br /> I DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. O <br /> ' 2.All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. ` <br /> r <br /> � <br /> �. Keep city atreeta cleasi at a13 tinzas. O <br /> 5. Curb gutter and aidervalk in fhe plat are n�av and undamaged, eny dama�e theret <br /> shAt! }ra replaced at the di9creYiora af tY�s t�ubtis Works tns�etor. a <br /> 5. Any ci�ange dn the dativ��y :rat must 6e �p�roved hy the Pub1Ar Worka Inepectaa, <br /> wldth at prop line Iimitad to eadsting aproa► width <br /> 7. Adjust water bcr�e to�ra8c at end n�°conatruot$�sn, <br /> 8. Drivewnyc rhali be �urnpletely cured beface drivang on thom. <br /> 9. Roaftap slrainage ahalF be d'asschargecR tn the Ivts�nffiltr�tion trench ae �� khe tity`s <br /> 'ReaidenHal itaof Ikowna�rout 9ystem" detnil and as per the lacation �nfarrnati�nn on <br /> the lot's eite pID�. Any chenge ln the lnrltrxitiar� tranch rnust 6e approved by the <br /> , Public Wori�e lnsgeckor. Catt for tcsspectt4n .priar to caucsting. <br /> . <br /> � \ . ACKNOWLEDGEMENT OF CONDITIONS <br /> _--) .�� � The undersignetl owner/applicant hereby agrees to holtl and save harmless . <br /> � / /�� � _ ___ 3+–L�_y` the City of Everett from any and all claims for damage� costs,oxpenses,or <br /> i �–s�–�� � — causes of action that may arise 5ecause of installation antl maintenance of <br /> ;� tovedtorConstruction Date theimprovementorotherrighbof-wayuseheretoappliedfoiandfurtheragrc�s <br /> � , to remove same upon notice from the City and to replace public property <br /> �, damagefJ thereby. <br /> i / <br /> FINAL INSPECTION �ate // ,� '� � S�. 5 .? ,y <br /> � Approved as Constructed � �. �/ �%, . - (�.- <br /> . Signature of Applicant Date . <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STAFiiED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO I <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CIiY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />