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Date_�� a�oi��wo,�sa�,m�i.�"`-�/"�'�3�.3i.. <br /> e�ea.oeo�.•��f�� <br /> Application For <br /> PUBLIC WORKS PERMIT °°°'°W°,k°Faa - <br /> Toinl Fce �—_ <br /> Less ADPI Fec Pa�a � <br /> Balan<e Due � �� <br /> Print or Type Onl/ — <br /> �u -��c-/113 - ��� � 9�'��� 5y6 -39G9 <br /> Owner ailing Address Gty Z�p Phone <br /> �--- � �I, <br /> Applirant ;dailing Address Ciry LP Phone + � <br /> / 1 +'sinip9• I <br /> Describe Proposed Work NI�LC� r�n��[� Mi �, i f(�f/D(P�t (.L �O'/ � ) /�((�P1{(Q��_ �� <br /> '-T <br /> TPirne�. � <br /> �- W <br /> Prolect Address(il known) �-�'3 1-3 �- ST 1.72 �E � <br /> Attach lour(4)copies of plans lor proposed work� Draw to scale and note Ihe following as applicable: � <br /> • Property Lines • Centerline ol sireel � <br /> • Outline and dimensions of all existing and • Indicate Norih �q/�p�qf1 12;53F� 0��3712 <br /> proposed slructures on ihe lot • Show any proposed gradidg bah2Je5 <br /> • Existing and proposed utilities • Show measurements � � <br /> DO N07 WRITE BELOV!THIS LINE BLDG . O <br /> PERMIT CONUITIONS �� ��� <br /> 1.All calls for inspeclion shall be maAe 24 hrs.in ad�ance-phone 259•8810. ��p � 560.� � <br /> 2.All work shall be pedormed in acwrdance with this permit and current Cily ot Everett Design a��onstm�� ri <br /> StandardsandSpecitications. �� �•� <br /> 3.Call Location Underground Service 48 hrs.before you di�.TOLL FREE NUMBER 1•800•�. � <br /> SEWQ`i 530.� <br /> BNO I 5110.00 O <br /> 4.ANY CHANGE IN THE DRIVEWAY CUT MUST BE APPROVED 11"11-5 5650.� <br /> RY THE PUSLIC WORKS INSPECTOR. ��7007 � <br /> 5.CONNECT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. �� :�•� � <br /> B.KEEP CITY STREETS CLEAN AT ALL TIMES. CNECY. 51571.� � <br /> 7.ANY DAMAGG TO THE CJRB AND SIDEWALK WILL EE REPAIRED <br /> TO T[IE SATISFACTION OF THE PUBLIC WORKS DEPT. O <br /> a ��� <br /> ,,.,, ACKNOINLEDGEMENT OF CONDITIONS � <br /> -�y��i <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less lhe Clly ol Everett Irom any and all claims lor damages, costs. <br /> expenses, or causes ol aclion that may arise because ol installation <br /> P� n `���/�� �- .�9�� and mainlenance ol lhe i nprovement or other ri�hl-ol-way use hereto <br /> �X. 1 applied tor and lurther agrees to remove same upon notice from ihe <br /> Approved lor Construc on Date City and�o replace public prope�ty damaged Ihereby. <br /> `.=,_�-� �,-a�, %.� ^��� 1 <br /> FINAL INSPECTION Date { � � �� �� <br /> Approv d as Consiruc�ed `8i�naWre ol Applicant Date <br /> WORK AUTHORIZFD BY THIS PERMIT N�UST BE STARTED WITIiIN <br /> everett PUBLICWORKSDEPARTMENT 1g0 D�YS OF DATE PERMIT IS ISSUED AND �HEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLtTION. TI11S PERMIT MAY BL <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS , <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />