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� t ;�-'� v . � <br /> k?`a� f � ?.:�•• . <br /> f � �; <br /> 6 : <br /> 'l.."`r� S'rkx i y <br /> nv. . . . , �` . . <br /> Datea���L_ � � � PuGlitWotk�PB�mile �� � _ <br /> '� � y Application For O�Cg.DeO��+ <br /> � y PUBLIC WORKS PERMIT PuUTaalFeeFee $ <br /> b H N <br /> �� � Lem RpO�Fae Paip .R O <br /> H T. [— <br /> p.� ealanco oue S J•� �� <br /> K y � Print or Type Only <br /> omo <br /> �il M �9 <br /> � zo � ,✓�„�L� � (� � 1�2S �P,41nN�/��r� ��'zG� 3�6�- �� �.� <br /> p N wner Mailing AdOress �.- `�� . , Ci�Y 2ip Phone <br /> � � � � ; r <br /> � • R l ' _S,�,Z� � � r ► " ` - <br /> q y � Applicant Ma�ling Address City Zip Phone <br /> r� <br /> H H �7 n ( <br /> $ N �,( ..A <br /> j b y Describe P�oposed Work,, ' �j� � /� ��'��/ ��L��'r��-1�� U�� <br /> � � ; p�ee,� _ —� fh�-e..+. ! ��q /�_—�-e_• ,rr1,.�t� n l er��r'.z i v��_3 �- <br /> � o � T_S'��. �x�_ ,r1-� n :�s � <br /> Projec�Address(il knawn) � � ✓ -'(L- � C ��u / ��_ � <br /> � <br /> Atlach four(4)copies ol pians lor proposed work-Draw to scalr.and note ihe following as applicable: �� <br /> • Properry Lines • Centedine of street ♦/� <br /> . • Outline and dimensions of all existing and • Indicate North V� <br /> proposed structures on ihe lot • Show any pmposed 9rading changes <br /> • Existing and proposed utililies • Show measurements � <br /> DO NOT WFITE BELOW TFlIS LINE � <br /> PERMIT CONDITIONS <br /> j-� --�, 1.All calis for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> I ._���. 2.All work shall be peAormed in accordance with this permit and current City oF Everett Design and Construction <br /> `=� Standards and Specificatlons. <br /> . � 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FBEE NUMBER 1•800•424•5555. � <br /> I <br /> I ��� 4. Rockery will conform to std. plan tt324. � <br /> e� 5. Erosion control measures wi-11 be added to or improved at the <br /> direction of the P.W. i_nsper,tor. � <br /> 6_ All. work to conform to Citv of EvereY,t Standards. <br /> 7. Existin� ratch basin� will be ]cept: clean. � <br /> ' �..� 8. Native veget,ation will be uti.li.zed where po�sible. <br /> 9. Street will. he kept r_lean and trarking of mud will. not be � <br /> tol=rated. Tf mud or sedi_ment ends up i.n th= street, remove it <br /> � '�' e immedi.atelv. If et;reet, i� not kept clean, the P.W. inspector wi.11. � <br /> I o i_ssue a STGP WORK ORDER t,hat. will. ata�� in eff.ect until the sY.reet <br /> is r,l.eanar] by sweapin@ met.hods. WASHING THE STRuET I� NO'P PERMISSIFII�li! <br /> � � [See� ��R�� �'l,K�� � ? <br /> � '�I� '� „�� �n/��(q CvNtq4D/Cr�yl ��C{{$'� ACKNOWLEDGEMENTOFCONDITIONS <br /> /VY" � The undersigned owner/applicant hereby agrees lo hold and save harm� <br /> �—`�� less lhe Ciry of Evereu from any and all claims lor damages, cosis. <br /> � ��� i ezpenses, or causes ot action Ihat may arise because of installation <br /> fe��� / � and maintenance of lhe improvement or other right-ol-way use hereto <br /> �� <br /> �� �. L�' -�=- � � � applied br and furiher agrees to remove same upon nolice from the <br /> App o, d o�C�enslrucf ; � 7 Date Cily and to replace public properry damaged ihereby. <br /> i � �_� � / <br /> ( , ,��'��i � l��l�- /�'- � 91 <br /> FINAL INSPECTION �� Date <br /> ApProved as Cor.slructed Si9nalure of Applicant Date <br /> PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarSlreet 180 D�YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Evurc�t,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> � Phone:259�8870 PROJECT OVEP 90 DA'!S DURATION. <br />