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1 <br /> ` Apptitalion For � ��� !� ^ <br /> � PUBLIC WORKS PERMIT Date � �Z�/q� <br /> PUBLIC WORKS DEPARTMEM' Public Works Permit A ��4'{(r�� <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8810 Building Permit M ���� <br /> IYPE OR PRINT ONLY E O PO S 1 I 17� SEP 1._7 �Q�' public Works Fee$_(�� <br /> Ma�lard }bm�s C�m �o► Co I�u �v� �'vr-} ae2.o� z5z-9�- <br /> Owner ��v ailing Address City Zip Phone <br /> David IZob�nel-I' <br /> Applicant Mailing Address City Zip Phone � <br /> Describe Proposed Work N ��� W <br /> _ � <br /> � <br /> PROJECTADUrIESS(ifknown) IqZ�L�Ot7t"pP,_.�1lPjYlU� � <br /> Attach fr�r(4)copies of pians for proposed work-Draw to scale and note the following if applicable: 07/c/9b 3:27FM OOOPtk690 <br /> •Froperty Lines 'Outline and dimensions of all existing and proposed structures on the�ot •Existing and proposed�utilities <br /> � �Centerline oi straet •Indicate North •Show any proposed grading changes •Show measurements qp005c068 � , <br /> DO NOT WRITE BELOW THIS LINE pLEG 563.00 <br /> PERMITCONDITIONS: MEGH 360.Q0 Z <br /> 1. All calls fo� inspection shall be made 24 hours in advance- phone 259-8810. ��� nn4�r„ O <br /> 2.All work shall be performed in accordance with this permit and current City of � Desi!''z ib <br /> Constru;.tion Standards and Specifications. , ., <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM��-�-4��$-�55. � <br /> WpTER 4550.00 �/� <br /> d. Rooftnp clrainagz shall b? disclia�-ged: =t000.z0727 V♦ <br /> SEWEs 570.00 O <br /> ��) T'o the site's sturni dr.iin syslem (private or publicj S�'SDEV 51295.00 <br /> b) 'fo a resideotial roof dotvuspout system desimied p�r,ectio�i�� oflhg19.4b a <br /> city stand:u�ds .md per the city's"Resideutinl RoofDownspout Systeiii' <br /> ciettil. <br /> c) t�nto splasL hlocks <br /> '1'fte tnctliod szlocted will be hubject to Public 1Vorke Dcp:ul:menl app�•o�-.il. <br /> `. Dri��eway nmst he paved from pmp.�y line. to edge of simet pn��ement. <br /> � � �� 4 ACKNOWLEDOEMENT OF CONDITIONS <br /> � ,,�A�� ���/�� The undersigned owner/app�icant hereby agrees to hold and save harmless <br /> �`/ the City of Everett 1rom any md all claims for damages,costs,expenses,or <br /> roved tor Construction ��e causes ot action that may arise because ot installation and maintenance of <br /> �P the improvement or other right-of-way use hereto applied for and further agmes <br /> ���� � /��� t° remove �ame upon notice from the City antl lo replace public property <br /> ��7 � damaged thereby. <br /> FIPW NSPECTION ` Date • <br /> Approved as Constructed <br /> � < <br /> at r Applicanl Date <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERM I ND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />