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�ate <br />0/25/90 C��i✓«✓R�� <br />Applicallon For <br />PUE�LIC WORKS PERMIT <br />Print or Type Only <br />��uoec Wa�aPermn • l�/� I 1 <br />❑�:�a oPni . 90 24955 _ <br />Puli�¢ Wo�ht fxe <br />,o�.�Fe� s <br />�,,,, ti��o� .�. P.,�, s <br />a,,���, « o�,�• S Z� r — <br />Sterlit�a FIom <�r= 792-6544 <br />pW�e� Maihng Atldress ity Zip Phone <br />Owner <br />Applicent Mailmg Atld�ess <br />Da9cribe Proposed Work <br />Zlp Phone <br />ProlectAddresslilknown� avna a���yhira Dr — �— <br />OB/^cl/9C 1:56FM OOOAN329:� <br />Attach four (4) copies ol Plans lor proposed work - Draw to scale and nole �he tollowing as apP��cablr: � <br />• Propei�y Linea <br />• Outlina end dimensions of all ezislinfl and <br />proposed structu�e� on the lot <br />• Eais�ing and proposeB u�ilities <br />• Centerline of strea� ' <br />• Indicate North b00024955 <br />• Show any n�onosed yradi6i�@6angesS�tBb.SD <br />• Show measurementx FLCG 855.GC <br />-�� OONUIWHIIttltLUW IMISLINt pLN CN 451.� <br />PERMITCONDITIONS B SRCH 54.50 <br />1. All cells lor Inspection shall be made 24 hrs. in a;fvance - phone 259•8810.� DF'ViJ1' 4�0.00 <br />2. All wark shell be paAormed in accerdance with this permit and current City ol Everett Desigq�jqfJ�ructlon <br />Standnrds and Specilicetions. 94.50 <br />3. Ce(I Locotinn Underground Service 48 hrs. belore you dig. TOLI FREE NUMBEi! 1•800•�'�-���. <br />SE4YcF: S'$p.0� <br />q000�4956 <br />4.APPLICANT SHALL INSTALL INFILTRAT?GN TRENCH, (8 CU. FT. M[pDbMUM f486.50 <br />FTLLED WITH DRA1N ROCK1 AND DIRECT ALL DRIVEWAY At'D ROOFIQ��GDRAII�fA� <br />MCCH 41�0.00 <br />B SRCH �w.50 <br />DF:VW�' f20.0C� <br />NODO?54T4 <br />f� S;iGH 44.�i0 <br />N0f�27899 <br />SEWER fT0.00 <br />CNt:C}; 5747^.�0 <br />(��.t�.� r 1 C��_ ! "�L– K/ <br />Approved lo� Con tryptlor Date <br />�"� �^�lCl� �oi•l —9J <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />everetl PUBLICN'ORKSDEPARTMENT <br />� J200 Cedar Slreal <br />Everett, N'A 9820' <br />Phone�.2S9�BB10 <br />HCKNOWLEDGEMENT OF CONC:'i i0N5 <br />W <br />I: K't: <br />� <br />� <br />� <br />O <br />a <br />The untlo ciy�ied ownedappiicant hereby agrees to hold and save harm� <br />less Ine Cdy ol Everet� 'ro�n any antl all claims lo� tlamages. cosis. <br />ezpenses, or causes oi xct o� ihat may arise because ol installat�on <br />and mainlenTnce ol the impr•7vemen� or other rlgh4ol�way use hereto <br />applied lor and fwther ag�ees lo remove same upon not�ce Irom the <br />Cily a¢d lo rePlace public pruperty dnmac,Jef3,thereby. <br />i.r.ir, <br />WORK AUTHORI2E� BV TtilS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br />2E CJILIGENTLY PUFSUFD TO COMPLETION. THIS P[RMIT MAV BE <br />CANCELLED 3V THE CITV UPON AN'/ STOPPAGE OF WORK ON iHIS <br />PROJECT OVER 90 DAYS DUPATION. <br />