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I �� <br />Date.5�211/9� <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />TO POSTING � <br />r�oimYm��,ve�mn. 50 �'�� � _ <br />oiea oeo�� • 90/24893 <br />o„o�,� wo,�,.sa <br />,o�a�.ee s — <br />LPS3 ADP� ie! ���d s _ <br />Bainn<e oue S 2-O ' _ <br />nr��hear� Cons�:. Inc. 17��.;;;���e�311 wav o201 Everett 98208 347-8484 <br />— pwner Ma�Nng Atldre:� Gry Zip Phone <br />owner <br />Applicant <br />Descnbe Proposetl Work <br />Prolect Addrnss Iif knownl <br />Mailin9 <br />City zic <br />Atla�h lour (4) cop�es ol plans ler proposed woik � Draw lo scale unA note the lollowing as appllcable: <br />• Property Lines <br />• Uulline antl A�rr.ensions of all e.isling and <br />' proposed struclures on the lot <br />• Eci�ting antl proposed utililies <br />• Centedine ot street <br />• Intliwle Norih <br />• Show any proposetl grading changes <br />• Show measurements <br />PERMIT CONOITIONS <br />1. All calls br inspecUon shull be mude 24 hrs. in ativence - phone 25J•8810. <br />2. All work shell be prdormed m accordauce with this permit and currenl City ot Everett Design antl Construction <br />Standards and Spe�ilications <br />3. Call Localion Under� rountl Service 4+i hrs. belore you dig. TOLL FREE NUMBER 1•800�424•5555. <br />4.ANY CHANGE IN THfi DRIViiWAY CUT MCiST BE A�PROVED <br />BY THfi PUBLIC ►.JRKS INSPSCTOR. <br />5.TIGHT LINS DOWNSPOUTS TO SIDE SSFIIiR. <br />6.KHfiP CTTY STRBfiTS CLHAN AT ALL TIMBS. <br />7.ANY DAMAGS TO THE CURB AND SIDhWALK WILL Bfi REFAIRED <br />TO THfi SATISFAl:TION OF THS PUBLIC WORRS DEPT. <br />1 ���C. � ✓' `� � `� Z �/ � �! <br />Approvetl lor Construction Dale <br />� <br />.�i���ti��— <br />FINAL INSPECTION Datc <br />Approved as Conslructed <br />everett �'UBLIC'^'OP��SD�iPAN!N,fNT <br />� 3200�cavS.re� <br />Eve��+L Y+a Dr.tC' <br />Phu� i:259"�e�n <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />Y / <br />O <br />a <br />The untlersigned owner/applicant hereby agrees to hold and save haim� <br />�ess the Cdy ol Everen Irom any and all claims lor damages, costs. <br />expenses, m causes of ac�ion Ihat may arise because o� installation <br />and maintenance ol the improvement or other iighPobway use hereto <br />applietl lor antl lurther agrees to remove same upon notice fwm the <br />Clty and to replace public property damaged Ihereby. <br />�yn. .;�1 �.�.�� ���T��d <br />Si9nature ol Applicant Date <br />WORK All"HOFIZFD OY THIS PEr7M1T MUST BE STARTED WITHIN <br />180 D°.YS OF DATE F'ERMIT IS ISSUED AIJD TNEREPFTER IS TO <br />BE DIL�GENTLY PURSUED TO COMPLETION. THIS PfiP:11T MAr BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OFV�Of:K C1`1 T415 <br />PROJECT OVER 90 DAYS DURATION. <br />, :: <br />* <br />