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— -- - ---- — - -- — - _— <br /> �----- ----- V _ 1= -1 S- 5 <br /> � . ^ �— �j c_Z �. <br /> I , ` Pu01¢Wo�ks Permit• 7 <br /> ✓'c�t@ �laq Deo� '��� x F— <br /> IApplication For <br /> F�UBLIC `JVORKS PER�IT P�bl¢WorksFeE s <br /> Total iee <br /> ( / Less RpO��Fee VaiO S— , <br /> TT W <br /> ��� 3alance Oue s G <br /> Print or Type Only <br /> �h / � �ys- �d�9 � '� <br /> ��'�_ �� j lv1U�I�.S�F�d�C f�� �� ��' L �tIH Zip Phone � <br /> Owner M�dmg Address ��n'1' <br /> �„ s �- ly3/ �o -'� y�pr��`f �id ac �/ ���7- a�� a <br /> )� �/ ( Zi Phone <br /> �P���a�� Madmg Address Crty P <br /> I � <br /> Ainu. �- /P �au�i/L �1Gr�-� L.o�� l3/'/ dltr� a f�,nPb�.i�( <br /> Describe FroFosed Work �T �' <br /> i / — I <br /> _ W ' <br /> _ � !�9 \Z �"�E�.�� �\vL <br /> Proiect Atldreas(it known) — � <br /> Attacn lour�4)copies of plans lor proposed work-Draw to scale and note�Ceo11ewine of street able: � ,I <br /> • Property Lines � Inaiwte North I, <br /> • Outline end dime�sions of all existing and � Show any proposed grading changes <br /> propoaed strudures on the lot � Show measurements M i <br /> • Existiop end proposed utilities W � <br /> DO NOT WRITE 9ELOW THIS LINE O I <br /> pERM1T CONDITIONS � �, <br /> t.All calle for inspecBon ahall be made 24 hrs.in advance•phone 259•$810• I <br /> I p.A��wprk shell be peAormed�n accordance with lhis permit and currenl City of Everett Desi�n and Construction <br /> Stenderds and Speoiflcetlons. � �,, <br /> 3.Call Locetlon Underyround Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. <br /> O I, <br /> ] . ](iSTALL COtiCRGT6 CULVERT PIP1? 7N iiliAINA�G DITC11 UNDGR DRIVEWAY . <br /> ;: .PAVi's I)RTV[:1�l�Y rROM PROFIsRTY L]NC: i0 F.AGE OF PA�'CD ROAD W1T[i � ' <br /> AiF11ALT CF.MisW'T <br /> � I <br /> O � <br /> � II <br /> ACKNOWLEDGEMENT OF CONDITIONS � <br /> The undersigned owner/applicant hereby agrees to hold and save harm- i <br /> less the City oi Everett Irom any and all claims for damages. cos�s. I <br /> expenses, or causes of action thal may arise because of installation <br /> .�--� and maintenence of the improvemenl or other right-of-way use hereto <br /> �._� `1i,C /Z � applied tor and further agrees to removr. same upon notice Irom ihe , <br /> Approved for Conslruction , / <br /> Oate City and to replace public property damaged thereby. <br /> . __-- <br /> � -� �� ��O <br /> '�— Date � �� Date �. <br /> FINAL INSPECTION Signature of APP�icant , <br /> �pprovedasConstructed WORKl�UTHORIZED BY THIS PERMI? MUST BE STARTED WITHIN <br /> everctt PUBLICWORKSDEPARTMEN7 1B0 DAVS OF DATE PEFMIT IS ISSUEO AND THEREAFTER IS TO �. <br /> � 3200 Ceder Sireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BC <br /> Everetl,WP.98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TH�S <br /> Phone :59-8810 PROJECT OVER 90 DAYS CURATION. — <br />