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I � APPtication Far � <br /> , PU�LIC WORKS PERMIT oate �%16/9u I <br /> i <br /> ; .. PUBLIC WORKS DEPARTMENT � i <br /> ! 3200 Cedar Street Public Works Pemtit q �_�3 <br /> � Everett WA 98207 259-8870� <br /> i � <br /> � Building Permit p__5(It;4h I <br /> � TYPEORPRINTONLY l'G POSTIN� ��r � �� <br /> i Public Works Fee$ ZF'j— <br /> llicnlin Tuc� 565 El.ia ll7 lidu�ot�de y�p��� � <br /> Owne , G7_—�1_� I <br /> Mailing qddress C�ry <br /> i Z'P Phone <br /> I <br /> I Appl�--_ Mailing Address I <br /> I C�ty Z�P Phone <br /> � Describe Proposed Work ncw h�,u:;e � <br /> i ; <br /> I � � <br /> I I <br /> I PRGJECT ADDRESS(if known) �_ � <br /> I <br /> !i !', i.�i�et�c�ur ,.a <br /> Lut j� <br /> IAttach four(q)copies of plans lor proposed work-Draw tn sca�e and note the followin it a licable: � <br /> � •Property Lines �putline and dimensions ot�I;existing and propos=d structures on the lot I <br /> � Oi:%03r'96 1!�39Ri`i ODt�R`45:� �, <br /> •Centerline of street •Indicate Nor,� •Show any proposed grading chan es ��istinq and proposed,ut(Ikies <br /> I9 •Showmeasurements,��0����- O� � <br /> PERMIT CONDITIONS: ��NOT WRITE BELOW THIS LINE ---- .-.__ � <br /> 1.All calis for inspection shall be made 24 hours in advance-phone 259-881p �D�n50E!��3 <br /> 2• ,411 work shall be pertormed in accordance with this permit and current City of,��rett Desip'�A�c� � <br /> Construction Standards and Specifications. I '' I <br /> � O i <br /> 3. Call Location Underground Service q8 hrs, before you dig. TOLL FREE NUMg�p4' �- �d:C`��UCC I <br /> u,,: i soo. <br /> i � j�'u'� �2�1.�3"". i <br /> i ` ''l.'d i:�l :�D. :;B � I <br /> �I. Keep city strec�s c;c,w at alt Wi,es. �#D�i�Pt'35 <br /> H'ATER 3l.t;5. ip O i <br /> I S. Ti�lrilinc drainage u�easement tu tl�e nortli mid discharge Uuougl� curb into ,iitt �uin a res�, ��tial side;ea <br /> drain as per riry st;mdard pl;u� #319. !�'D03D526 � <br /> ' ti. Side scwer shall be uutatled es per stnndard plun�'GOl Fc r+6pi, ' � �N` � � y � <br /> S;'SC�EV RE.UO.D(i ' <br /> � E. <br /> �NECf: *t573._'t: � <br /> � , <br /> � � <br /> � <br /> � <br /> I <br /> � i <br /> � I <br /> ._ <br /> , �1� i <br /> � <br /> j � <br /> I <br /> - ACKNOWLEDGEMENT OF CONDITIONS <br /> `�� The undersigned owner/applicant hereby agrees to hold and save harmless I <br /> ; , , c/ c� �c <br /> ApproJetl for Construction — � tha City of Everett from any and all claim�for damages,costs,expenses,or j <br /> � Qate �— causes of action that may anse because ol installation and maintenance of <br /> I � . ,�� theimprovementorotherrighbof-wayuseheretoappliedforandfuAhera9mes ', <br /> _ -' .-c; to remove same upon notice from the City and to rep�ace public property <br /> � FINAL INSPECTION ` � ` � � � ��� tlamaged thereby. � <br /> ' Approved as Constructed Date � � � <br /> �� J\� ��f�'E^ (�. I <br /> ' /no-rili� � t� S� ! <br /> ,. Sigramre oi Apppcant <br /> f WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DqYS OF DATE PERMIT IS ISSUED AND iHEREAFfER IS TO BE DILIGENTLY PURSUEDaTO I <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAVS DURATION. � <br /> � <br />