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. <br /> Date�v PuCI¢Wo�ha Pc�mp� �/�� <br /> Application For BIdB.Uept�,� /� � . <br /> PUBLIC WORKS PERMIT PubTO101FC�Foe S <br /> LesSAOPI FeePa�tl � <br /> Print or Type Only � e��,�«o�� s �—��' _ <br /> IA)rrv��wvnr, ,-vtto f�'3�Gx /O�a Gv��ni r �aifl- 9�1"i�L6 5�(n — ��q <br /> Owner Mailmg Address � City Zip Phone <br /> Sn wi � <br /> Applicant Mailing Address Ci'y 2ip Phone '��; <br /> � � •;.:: <br /> Describe Proposed Work _�_e.0� �r ✓1G I P ���/ /l/ (�(� ���y.�_�! � ^��- C �p �' �,-sp. <br /> (� "' <br /> ?roject Address lif known) �-'' 3�� � �-ST QZ- `�c � <br /> Aflach four(4)coU�es oi plans lor proposed work� Draw to scale and note Ihe lollowing as applicable: � <br /> • Property L+nes • Ceaterline ol sireet � <br /> • Outline antl dimensions ol all exisling and • Indicate Norih <br /> proposed siructures on Ihe lot • Show any proposed grading chanqes <br /> • Existing antl proposed utilities • Show measurements �y�18/90 1�0�^Ftt OOOHq3714 � <br /> DO NOT WRITE BELOW THIS LINE <br /> �00�^5117 O <br /> PERMITCONDIT�ONS BLDG 5576.50 <br /> 1.All calls for inspecUon shall be made 24 hrs.in advance-phone 259-8810. �� � � � <br /> 2.All work shall be pertormed in accordance with Ihis permit and current City ol Everett Desi{��cl Constr{�r� <br /> Standards and Specifications. <br /> 3.Call Location Urderground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800-$�55. s�'� � <br /> ORUW $20.U0 <br /> H0000700k O <br /> 4.ANY CHANGS IN THfi DRIVEWAY CUT MIIST BE APPROVED �TER 360.00 <br /> BY THB PUBLIC WORKS INSPisCTOR_ H00027931 <br /> 5.CONNfiCT DOWNSPOUTS TO POBLIC DRAINAGE SYSTEM. �� S30.t70 � <br /> B.KfiSP CITY STREfiTS CLEFN AT ALL TIMES_ 6ND I 5110.00 <br /> 7.ANY DAMAGfi TO THE CURB AND SiDEWALK WILL BE REPAIRED 1171-5 i650.00 '�\ <br /> TO THE SATISFACTION OF THE PJSLIC WORKS DEPT. CHECI; 51571.� y� <br /> O <br /> a <br /> ACKNOWLEDGEMFNT OF CONDITIONS <br /> � �� The undersigned owner/applica�' �are6y agrees to hold and save harm- <br /> less the Ciry ol Everetl irom ; � nd all claims lor damages, cosis. <br /> expenses, or causes of action �. ray arise because ol inslallation <br /> CV�c�C_, and maintenance of lhe im ro . t or other ri ht�oFwa use hereto <br /> ��"� �� ` �� ���J� applied for and Imther agree:• �. .move same�ipon nofce hom the <br /> Approved lor Constru ti �a�e City and to replacc public pro, � 'y dsmaged thereby. <br /> �fC/��� ��f� 's� ����„Vc <br /> FINAL IrfSPECTION Date <br /> Approve as Constructed Signature ol Applicant � Date <br /> everett PUBLIC WORKS DEPARiMENT WORK AUTHORIZFD BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THFFEA� "ER iS TO <br /> Everett,WAgB201 BE DI�IGENTLY PURaUED TO COMPLETION. THIS PERN'f �AAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />