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� � <br />q �� <br />��W <br />►d � <br />� �'U <br />tA <br />'� <br />��C <br />� � <br />QMV <br />Z>M <br />t'� y <br />N <br />w <br />�y M <br />W w <br />O� <br />u� <br />� <br />1 �� <br />� �� <br />Date�O <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />TO POSTING_ '� �a� 9�- <br />Pu01¢ WorMf Po�mit • �I3�1O ! � <br />eiav oem.. 90/24891 _ <br />Puel¢ N'orha foe <br />lo�nlFBe s - <br />Le5�Rp0� �ee V.1r0 S _ <br />Ba�ance Due S 2� r <br />Breshears Const. Inc. 111 SE E�•erett Mall Way D201 Everett 98208 347-8484 <br />Owner Mailing Addre55 City Zip Phone <br />o.mer <br />Applicanl <br />Describe Proposetl Work <br />P�oject Addrass lil knownl 4017 Gcand <br />Gty Zip Phone <br />Attach lour (4) copies ol Fl�ns lor proposed work - Drav.� to scale and note tne lollowing as applicable: <br />• Property Lines • Cenlerlin� ol street <br />• Outline and dimensions of all ex� :ting and • Indicale Norih <br />proposed structures on Ihe lot • Sho�v any proposed �jradmg Uanges <br />• Ezistiag and proposed utfldies • Show measwemenl5 <br />PERMIT CONDITIONS <br />1. FII Cell9lor InSpection Shall be maCe 24 hrs. in advance • phone 2$9•8810. <br />2. All work shell be performed in accordance with ihis permit and current City ol Everelt Design and Consiruction <br />Standards and Specifitations <br />3. Cail Locatlon Undergrou�d Service 48 hrs. betore you di;. TOLL FREE NUMBER 1-800-424•5555. <br />4_ANY CHANGB IN THE DRIVEWAY CUT MUST BE APPROVSD <br />SY THH PUBLIC WORKS INSPfiCTOR. <br />5.TIGHT LINE DOWNSPOUTS TO SIDS SfiF1ER. <br />B.KEfiP CITY STRSHTS CLEAN AT ALL TIMES. <br />7.ANY DAMAGH TO THfi CURB AND SIDHGIALK WILL BE REPAIRED <br />TO THH 59TISFACTION OF THH PUBLIC WORKS DEPT. <br />�Ol.�.�% �'yI `k�_ '7 - Z L - 9D <br />Appnved lor ConstruGion � Date <br />i ,� <br />ci��/' -f`---'__. <br />FINAL INSPECTION Dz:e <br />Apnroved as Constructed <br />evcreu PUBLIC WORKS DEPARTMENT <br />� � 3200 Cetlar Street <br />E��:i� Y "/A 9E201 <br />1 ���:.^3P�F310 <br />ACKNOWLLDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />♦�� <br />V♦ <br />O <br />a <br />The undersigned owneqapplicanl ne�eby agrees to hold and Save harm- <br />less the City of Everelt irom ai�y and all claims for damages, costs. <br />expenses. ur causes ol aclnn that may arise because ol installation <br />and maintenance of the im�rovement or ot�er righPo4way use hereto <br />applictl br and further agrces ro remove same upon notice irom the <br />Cily and to replace puhlic prnperty damac�ed thereby. <br />Signatm^ ot ApP'icznt <br />� WORK AUTHORI2ED GY TH�S PERMIT MU6i 9E STARiED WITHIN <br />I 780 DAYS OF U�TE PE9�dlT IS 13SU.ED ANO THEREAFTEti IS TO <br />� BE DILIGENTLY FUFS�EC '� CO:'PLETION. THIS PERMIT MAY BE- <br />CANCELLED RY THE CiT'i 1,��0�. �� �'-GPPAGE OF WORK ON THIS <br />' PROJECT C-.�ER 90 DA�'.; -. F, � <br />� <br />