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Application For <br /> 4.77. • PUBLIC WORKS PERMIT Date 7 /16, ' <br /> PUBLIC WORKS DEPARTMENT Public Works Permit# <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8810 p w (� ®/b <br /> Building Permit# <br /> (;�JO <br /> TYPE OR PRINT ONLY Public Works Fee$ 2Q <br /> 569 <br /> JUDY DAVIDSON, 14300 Trillium Blvd SE #4, Mill Creek WA 98012 (2O6)338--2222 <br />;' Owner Mailing Address City Zip Phone <br /> SAME <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work Grade driveway and ditch for utilities into lot 3 of short <br /> W <br /> plot 1202-32-93 across .,butt easement. <br /> PROJECT ADDRESS(if known) c ','/o ""' <br /> Attach four 4 copies of plans for proposed work Draw to scale and note the followingif applicable: <br /> � ) p p p <br /> (.1 i .1 "' -15 <br /> " �f .�..s.a>�;,1rii <br /> •Property Lines. 'Outline and dimensions of all existing and proposed structures on the lot 'Existing pnd proposed utli#ies,c. <br /> 'Centerline of street ■Indicate North 'Show any proposed grading changes 'Show measure t "t=;y ,..,r:r Go <br /> DO NOT WRITE BELOW THIS LINE <br /> kE <br /> PERMIT CONDITIONS: <br /> agni <br /> f 1. All calls for inspection shall be made 24 hours in advance_ phone 259-8810 ; <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and, 0 <br /> Construction Standards and Specifications. <br /> 3' Call Location Underground Service 48 hrs. before you dig. DOLL FREE NUMBER 1-800-424-5555. <br /> rr 4 0 <br /> 0 <br /> INNIMMINIM <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harmless <br /> the City of Everett from any and all claims for damages,costs,expenses,or <br /> f` ! causes of action that may arise because of installation and maintenance of <br /> Approved C struction Ddte <br /> the improvement or other right-of-way use hereto applied for and further agrees <br /> to remove same upon notice from the City and to replace public property <br /> damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed ,. <br /> Signafure of Applicant ate <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />