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Date 9"'.1 ""+ Plifil <br /> 59 / Public Works Permit# /f, /.v <br /> L �! Bldg.Dept.# 49471 <br /> Application For 1,-1 <br /> PUBLIC WORKS PERMIT Public Works Fee <br /> Total Fee $ <br /> Less Appl.Fee Paid $ <br /> Print or Type Only j " EA ER g Balance Due $ 2©°- <br /> .Z6 cl t <br /> :4 l <br /> George Hawkinson 243 Elm, St #204 Evere . 9 203 259-3448 <br /> Owner Mailing Address City ES�� 4 ip Phone <br /> C.3 ,?.; Es t <br /> Owner <br /> 9 � '. <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work driveway <br /> w <br /> Project Address(if known) 616 Olympic Blvd <br /> Fill <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North CO <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> al <br /> DO NOTWRITE BELOW THIS LINE <br /> PERMIT CONDITIONS 0 <br /> 1..All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. N <br />' 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. <br /> (� 2:41'nn :: -fi✓ ./.:+ C F J eG-G „,,i 4 ...4,..4.1°..e, of0 <br /> (1,4.:. 4'114 . . '' , ` . ,C ce 6 ,01.64 z , <br /> 0Cn as <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm-- <br /> less the City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> C _.,„0:,/ 0,e44...„ 0' p <br /> s .� and maintenance of the improvement or other right-of-way use hereto oi <br /> Approved for nstruction Date applied for and further agrees to remove same upon notice from the <br /> City and to replace public property damaged thereby. <br /> , .� ref r, ,)f r.� <br /> FINAL INSPECTION Date "' f t <br /> Approved as Constructed Signature of Applicant / date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> ciW Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />