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� � <br /> Date ����i� � O '�' ���0 34-5 <br /> Pu�hcWorFgPo� ,�,�.-r�)�—� <br /> 0149 OePI �J -�—�=z-� <br /> Applicalion For -+ <br /> .�a <br /> PUBLIC WORKS PER�IIIT 1ueTot,iFec`eP � <br /> � less Aopl Fee Vai f S � <br /> g � or�. � 8 g $^�� S `�^" <br /> Print or Type Only � Qy7y.p7 <br /> � d `�O `�ON N � � MO �OIII <br /> M N M L� M <br /> � ' �� ��� �(Ip-���9 <br /> Owner M�iling Address m ��t� Z � � � � � p �� Phone <br /> $ � m � �E .�-� <br /> qpplicant Mailing Address Ci1y Zip Phone � <br /> c�'I�i2 � T�� (n'-� f"V p . �� � <br /> Describe Proposed Work � <br /> .�+-`,, 'it�_. <br /> I G- � /1/YQ __-.r.r <br /> --��� F�-L-_e— <br /> W <br /> Froject Address(il knownl i�231 - � s� �2- 5� � <br /> Atlach tour(4)copies M pla•�s lor oropcsed work- Draw 10 sr..le and note the fo!loa�in�as apPlicable: � <br /> • Property Lines • Genterlinr. ol sireet � <br /> • Oulline and Cimensions of 211 eaisting and • Indicate North <br /> proposed structures on ihe lot • Show any proposed grading change� <br /> • Existing and proposed utilities • Sl•�ow measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current Ciry ol Everetl Design and Consuuclion <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800-424-555$. �`q1 <br /> ` <br /> 4.ANY CHANG6 IN THP DRIVfiWAY CUT MUST BE APPROVfiD O <br /> BY THS PUBLIC WORKS INSPSCTCR. � <br /> 5.CONNfiCT DOWNSPOUTS TO PUBLI': DRAINAGE SYSTEM_ <br /> 6.KSfiP CITY STRSfiTS CLTAN AT ALL TIS�IES. !w <br /> 7.ANY DAMAGfi TO THfi CURS AND SIDTsWALK WILL BE RfiPAIRED y� <br /> TO THE SATISFACTION OF THE PUBLIC WORKS D}iPT. O <br /> a <br /> ) PCKNOuVLFt rNT O� CONDITION` <br /> �fLy Tha w�der;iq��ed m•:nedap� � .en by agiees to hold and save harm- <br /> less ihe Ci'y ot cvriPlt fr �, > and all claims lor ramages, costs. <br /> expenses. er causes of ar �� th.:t nay arise becauso of installation <br /> ��`/� .^^��- �_23_� and mairlunance nt the Im4 _.emen' or other riyht�ol��+ay usc her'eto <br /> �"" � _ applied to� and lur;her ag�ees lo remooe same upon notice from the <br /> A��proved br Consirutlion /� �a�' Ci1y and tc re0lace puUlic orooeny d��maged Ihereby. <br /> %`��i� ,�-�C- // , !/, � <br /> FI VAL IN P CTION Date ��Y�C — <br /> p��provedasConstrucled �/ i�,olAoplicant —�e ���`' <br /> WORK AUTHORIZED B\ THIS PEFMR MUST BE STAqTEO WITHIN <br /> evcrct[ PUBLICWORKSDEPARTMENT 180 �AYS OF DATE PERMIT IS I.SUED AND THFREAFTEN IS TO <br /> �� � 3200 Cedar Street BE DILIGENTLY PUHSUED TO COAIPLETION. 7HIS 'Efib11T b1AV BE <br /> Everetl.WA98201 CANCELLED BY THE G(Y UPON AtJY STOPPAGE OI"WORN.ON iH15 <br /> Phonc:259�8810 pRpJECT OVER 90 DA"5 DURATION. <br />