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Date�C.' Pu�ec Works Permi � �'� <br /> � Applica�ion For emc Deo�.� <br /> PU�LIC WORKS PERMIT °°°��°W°«BFCe — - <br /> Totnl fec S— <br /> Q LC55400�FPB Pdid � <br /> U <br /> N g � � � � �j � � � Balunce Due �� <br /> Print or Type Onl� v; N o a o 0 o c� o vi <br /> ��� m Ifl 0� Nl �J V� �"l .'4 N � <br /> .+ �l M bi tl> W � bi N � <br /> � I'1'�v �Ba7� <br /> �. <br /> o I �{-r��''� �1� . � �y 1�I� <br /> Owner � c'� �t����Qg��s � City LP Phonc <br /> -�� o co co x re .�. i� <br /> .r 0041 [.� U) ? � i— O 3 � L� f�J <br /> \ O _I J W � O Q �J W 2 .—� x <br /> � � � a � � o � � � �� ;� ... � �,y��� <br /> App�iwnt Mailing Address City Lp Phone <br /> Descri6e Proposed Work ��� ��� ��� �� <br /> - W <br /> Prolect Address lif knownl �Z-'�"� � 1.ST D2. S� _ � <br /> Aflach four(4)copies of plans for proposed work- Draw to scale and note Ihe lollowing as applicable: � <br /> • Property LinPs • Centerline ot streel � <br /> • Outline and dimensions ol all ezisting ond • Indicate North <br /> . proposed structures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> �U NOT WRITE BFLOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advence•phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with Ihis permit and wrent Cily ul Everett Design and Construction <br /> Standards and Speci!ications. <br /> 3.Call Localion Underground Service JB hrs.betore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> 4.ANY CHANGfi IN THE DRIVEWAY CUT M[JST BE APPROVSD � <br /> BY THE POBLIC WORKS INSPBCTOR. <br /> 5_CONHfiCT DOWNSPOUTS TO PUSLIC DRAINAGfi SYSTEM. H <br /> 6.KSfiP CITY STRfiI3TS CLEAN A� ALL TIMES. <br /> 7.ANY DAPIAGE TO THE CURA AND SIDEWALK WILL BE REPAIRED �/� <br /> TO THE SATISFACTION OF THE PUBLIC WORKS DEPT. ��� <br /> O <br /> a <br /> ACKNOWLEDGEMENT OP CONDITIONS <br /> The undersigned owner/applicant hereby agrecs to hold and sa�e harm� <br /> — — less the Cily ol Everett imm any and all claims lor damages. costs, <br /> expenses, or causes of ac�ion that may arise because ol in:�tallation <br /> � I,�q and mainlenance el the improvement or other righ4ol�way use hereto <br /> � i �,V I e �� �^ 1 S— � applied tor and lurlher ayrees to remove same upcn notice iwm the <br /> Approved for C �ructioD Date Cily and to replace publir.properry dama9ed thereby. <br /> ���% � -a� - s. /`� =s/�- �S��`�l(� <br /> FINAL INSPECTION D:de <br /> Approved as Constructed Si� ,ture ol Applicant Date <br /> evere[t PUBLICWORKSDEPARTMENT ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFT[R IS TO <br /> � 320U Cedar Streel BE DILIGENTIY PURSUED TO COMPLETION. THIS PEFMIT MAY B[ <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�B8t0 pROJECT OVER 90 DAYS DURATION. <br />� <br />