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TYPE OR PRINT ONLY <br />Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />�� �Z is-I l.. V1') 0)2G-191J � S 1 � ���=1��r'-W L <br />Owner Meiling Address � <br />VI�Z(,-1� /y�,�IZG-v+u �3l <br />ApPllcent Mailin5 <br />Describe Proposed Work G` �yr) <br />PROJECT ADDRESS (if known) <br />Date ���Z-���(p <br />Public Nbrks PertnN M �� <br />Building Permit 8 � <br />Public Works Fee S �J <br />� �:� 7. 9�� o <br />V!= � ✓�7— <br />� <br />���I <br />Zip <br />: WA � <br />-� vse , <br />��(,-�sz-r <br />'�-D(, - �Yz-/�F-� <br />G <br />Attach four (4) copies ot plans {a p�p� Work • Draw to scale and note the following B appl(cable: � 1_'.- ��4i 9f� �� �? 9F,y QI]($i`�g+ <br />RropertY Lines `Outline and dimensions of all exlsting and proposed structures on the bt •Exlsting and proposad'utilities <br />'CentMine ot st�eet •Indicate North 'Show any proposed grading changes �Show measurements 1400095��.S..T• <br />- - - hEIV�t�.� 3�n_nn <br />....�.v� •�n�icocLVW IF7IJLINt '_tY�N ;.^[l._�1 <br />PERMIT CONDITIONS: <br />1. All calls for inspectfon shall be made 24 hours in advance - phone 259-8810. <br />2. All work shal� be performed in accordance wkh this permit and current City of Everett Design and <br />Conshuction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5565, <br />d Driveway dimensione and locntinna ehn11 lm per fhe ;tpprn�•ed plan dated 12i2d�9b and atfnched to <br />thie permit <br />5. Use no re-ba�� or wire mesh reinforcin,g in concrete. "It�e new cement coucrete clrivewaye shail be � <br />thick. Comply with e�ction 3-19.3(5) thni 3-19.3(8) ofUic city ofEverett LesiRn a��d coushurtiou <br />stAndm'ds and specitications (altached). <br />ti. Broken or damaqed civb d' i alk h <br />_ an su etv e sili be rep�aced or repwred et the Pubiic Works G�epectore <br />diractiun <br />.�0. A minimwn of 18' ofgr;u3a pm�klvay ahall be maintflined (reinstalled) behu•een Qie hvo cL�ive�vtrys on <br />�this properta'R fronfaac <br />�`%J r/�LL�tdL o��Ti� v�r�}1s on Gr�+vL L�sl-�� <br />CI��V � �-- r�Z+� u/H'�' 1, �/ <br />% <br />, <br />- ACKNOWLEDGEMENT OF CONDITIONS <br />� The underslgned owne�/applicant hereby agrees }o hold and save hartnless <br />� . (z �L � the City of Everetl from any and all claims for dameges, cosis, expenses, or <br />for nstru Ion p�iB causes of action that may ar(se because of Installatbn and malntenance of <br />the Improvement or other rigM-of-way use nereto applled }orand furtheragrees <br />to remove same upon notice from the CIty and to replace publlc property <br />damaged thereby. <br />FINAL INSPECTION Date �- <br />Approved as Constructed / i <br />✓- �.�! a///. �Z - zu--s� <br />Slgnature of AppNcaM/ Date <br />WORK AUTHORIZED BY THIS PERMR MUST BE STARfED WIhIIN 780 DAYS OF DATE PERMR lu ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PEflMR MqY BE CANCELLED BY THE CIN UPON ANY STOPPAGE Of WORK ON THIS PR0.IECT OVER 90 DAYS DURAT70N. <br />