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Date�G Pubiic WmMs Pormil• �/_�LV <br /> , � Applicalion For emq.oen�.•��—. <br /> PUBLIC WORKS PERMIT �'_01¢N'aih^^. ,. _— '-- — <br /> i� �i iPn <br /> LessRK� Fe��4a� � �- - �-- <br /> Balnnce Dua S L'�J . . . <br /> Print or Type Only — �-- - <br /> .�ij �t i a �,.. :;� IL,,,o c� ��D� 1�rn� /!'I �� L�in��v�a�/��9.�s�6 5�/(o -:39�9 <br /> wner Mailmg Address Ciry Lp Phone <br /> .�:it;�:9'.L --�c <br /> ` ,- „���� Afailing Addmss City Zip Phone <br /> 1�', 1 Pinn�P * f��v v�/1vLt0 LnT� � '� �il./fPi.df/RN" /P/Y15�/ <br /> Uesc+ibe Proposed Work �c�q/��---�-D'/M—�--.--� - � <br /> W � <br /> Project Address(il M.nown) �'�2'�] - 1- 5T DIZ S� __ _ � <br /> Attach low(4)copies ol plans lor proposed work� Draw to scale and rote the lollowing as applicable: 'I <br /> • Property Lines • Genlerline ol streel � <br /> • Outline and dimensions ol all exlsting anJ • Indicate Norih tn�q�7 e51��� ��3715 <br /> proposed siructures on the lot • Show any proposed grar��twang <br /> • Eaisting and proposed ulilities • Show measurements � � I <br /> DO NOT WRITE BELOW 7N15 LINE �p('j , O I <br /> PERMITCOND�TIONS �� ��� <br /> t.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. �-� s�'� I <br /> 2.All work shall be peAormed in accordance with Ihis permit and currenl Cily of Everett Desi��donstru�� � I <br /> Stendards and Specilical�ons. DI'VMl 52�.�Q <br /> 3.Call Lowtion Underground Ser:�ce 48 hrs.before you dig.TOLL FREE NUMBER 1-800-���. � j <br /> SE.WER s30.00 <br /> 8hU I lI10.00 O <br /> 9.ANY CHANGfi IN THE DRIVEWAY CUT MUST BE APPROVED 1171-5 f650.0U <br /> BY THfi PUBLIC WORKS INS2ECTOR. �=��6 <br /> S.CONNECT DOWNSPOUTS TO ?UBLIC DRAINAGE SYSTfiM. WAIEft f60.00 <br /> B.KEEP CITY STREETS CLEAN AT ALL TIMP�S. CHECF; 51571.00 � i <br /> 7.ANY DAMAGfi TO THE CURB AND SIDL'WALK WILL BE REPAIRED <br /> TO THE SATISFACTION OF THE PUBLIC WORKS DfiPT. � <br /> a � <br /> r` - ACIQ� .EDGEh1ENT OF CONDITIUNS . <br /> i � <br /> "�,�L The undersigned o� � .�plicant hereby agrees to hold and save harm� <br /> - Icss Ihe City rf E. -� from any and all claims lor damages. cosis. <br /> /� expenses, or cau: � ' action Iha� may arise t�ecause of installation <br /> -- �_ / n �'A��e .7-j y_� and maintenance oi tne improvement or other right�ol-way use heret.. <br /> �(�j�SC, r t applied lor and lurlher agrees to remove same upon notice irom the <br /> Approved loi ConslruGion �a�e City and to replace puhlic properry damaged thereby. <br /> ����i r� �y % '��.�/ � ' � �/� <br /> FINAL IPISPECTION �a�e � ����� � ���� <br /> Approve 1 as Cons�ructed S�gnature ot Applicanl � Dat� <br /> WORK AUTHORIZED Bl' ThIIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 1g0 DAYS OF DATE PERM�T IS ISSUED AND THEREAFTEI? IS TO <br /> � 3200CadarSireet BE DILIGENTLY PURSUED TO C0�9PLETION. THIS PEHMIT MAY 8[ <br /> Everell,WA98201 CANCELLED BY THE CITY L'PON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8870 PROJECT OVER 30 DAYS OURATION. <br />