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/ <br /> Date 1z �� y3 TO P�4TING 7— ZS'- 9'� I PUELCWarbPermit� _�31�� <br /> ema.oeci.. ��L <br /> Application For <br /> PUBLIC WORKS PERMIT PUOToteFeeFee s <br /> Leas�oc�Fee PeiC s <br /> B�ience Doe S � <br /> Print or Type Only � <br /> W <br /> U IOn �iPA��. I ID 1" 'F� I� �G uG �1G�/ fo4t"L'�L3 � <br /> Owner <br /> Mailing Address City 2ip Phone <br /> Mailing Address City Zip Phone <br /> qpplicant F� <br /> 1, < <br /> Describe Proposed Work tJ(i�V �A15G �A25�G 2�(v � <br /> W <br /> Project Address(it known) <br /> sn - �� sE "z � <br /> � <br /> Attach four(4)copies of plans 1or proposed work- Draw to scale and note the following as applicabte: � <br /> � Property Lines • Centerline of street <br /> • Outline end dimensions of all ezisting and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All cells for inspection shell be mede 24 hrs.in advance-phone 259•8810. <br /> 2.All work shell be pertormed in accordance with this permit and current City of Everett Design and Construction <br /> Stenderda end Specificatlons. � <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�424•5555. <br /> 4_ Install rock construction entrance behind drivewaY as per O <br /> Citv atandard it208 and erosion contro]. as directed bv Public <br /> Works Inspector. � <br /> 5. Keep city streets clean at all times <br /> 6 a v�damagerthereto shall be replaced atethewdiacretaonaofdthe � <br /> Public Works Inspector. O <br /> 7, Any change in the driveway cut �nuat be approved by the Public <br /> Works Inspector. � <br /> 8. Tightline all roof, ,yard and dr?veway draine to storm drain <br /> stubs at back aide of sidewalk. <br /> 9. Adiust water boxee to grade at end of conetruction. <br /> 10. Drivewave ehall be compl.etely cured before driving on them. <br /> /��/ ACKNOWLEDGEMENT OF CONDITIONS <br /> �1� r �n or� '1�.�� The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City ol Everett from any and all claims for demages, cosis, <br /> /'� expenses, or causes of action that may arise because of installation <br /> { /�1 � „�^� ��,/ ����� and maintenance of the improvemenl or o�her right-ot�wey use hereto � <br /> � (��1 G� applied lor and further agrees to remove same upon notice irom the <br /> Approved for Constr ion � Date City and lo replace public property damaged thereby. <br /> '-Sc=�<a�./. � (� - ? z-vY � I/�' ,/� /�-,?`l • I.3 <br /> FINAI INSPECTION D te ' ��� "`�G�� Date <br /> Approved as Consiructed Signalure ol ApPliwnt <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � PUBLICWORKSDEPARTMENT 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Ceder Street BE DILIGENTLY PURSUEC TO COMPLETION.THIS PERMIT MAY BE <br /> Everet4 WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 D4YS DUr7ATION. <br />