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/ <br /> Date�/ / �3�q('J PuOLc Worha Peemlt• � 33�_I <br /> / n Application For eieo 000i.. S <br /> v <br /> PU�LIC WORKS PERMIT Pu�licWorksFea <br /> totnl Fee s <br /> 1 <br /> � Le56 AOPI.Feo Pala S <br /> Print or Type Only ' ; ae�r���o�� S z-�' <br /> ' �c �� �' .. - <br /> i�'. : ��� . ' <br /> '� .. ,i . .. ���i <br /> !n u <br /> C <br /> QS �? "' , � 96} <br /> �d )�rn�/��vP��`: x ��LZ�a � vr�hr�/dod �i Ili� �G/ S 6 3 <br /> Owner �-. MaiLoqAtldresc: � - dy Zin Phone <br /> - . a •�,i : . , , <br /> . ; i . _ � •..� , .� <br /> '' � � . � � :' ', , .. <br /> C^ c <br /> �l � � �� _ . _ ' _v , . . .. <br /> Applieant Mailing Address Ciry Zin Phone ����- <br /> Describe Proposed Work <br /> �,�rn�',�O[LCO �IY f lAC�- � <br /> W <br /> Prolect Address(if known� � 3Z1 — 1 S� I�Z 5� � <br /> Attach four(4)copies ol plans lor proposed work- Draw to scale and note ihe following as applicable: � <br /> • Properry Lines • Centerline oi street � <br /> • Outline and dimensions ol all existing and • InAicale Norlh <br /> proposed siructures on ihe lot • Show any proposed grading changes <br /> • Exis�ing and proposed utililies • Show mcasurements � <br /> DO NOT WRITE BEIOW THIS LINE O <br /> PERMITCONDITIOIJS <br /> t.All calls(or 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 of Everett Design and Ccnstruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 4.ANY CHANGE IN THE DRIVEWAY CUT MUST BP APPROVED O <br /> BY THE POBLIC WORKS INSPECTOR. <br /> 5.CONNECT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. � <br /> 6.KfiSP CITY STREETS CLEAN AT ALL TIMES. <br /> 7.AP?Y DAMAGE TO THE CURB AND SIDEWALK WILL BE REPAIRED N <br /> i0 THE SATISFACTION OF THE PUBLIC WOFKS DEPT. O <br /> a <br /> 1 ACKNOWLEDGEMENTOFCO� �' JS <br /> U <br /> �� The undersigned owner/applicant hereby agres . .old and save harm- <br /> - — less the City of Everett Irom any and all cla. 'or damages, costs. <br /> ezpenses, or causes of action that mny arise because of installation <br /> � �w1 �� �-��—�`J and maintenance ol Ihe improvement or other right�ol-way use hereto <br /> Cpli applied lor and further ayrees to remove same upon nolice irom the <br /> Approved for Cons�ryc'ion Dale �i�y and lo replace public property damaged thereby. <br /> —��-.� �- .7-.16 � / � ` � � / � c � <br /> FI�AL INSPECTION Date ��L(.- � L/ "/ <br /> Approv 'd as Constructed Signature oi Applice t �Date <br /> WORK AUTIIORIZED BY THIS ERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTPAENT 180 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS 70 <br /> � 3200 Cedar Streel BE DILIGcNTLY PURSUED TO COMPLETION. TH�S PERMIT MAY BL= <br /> Evered,WA 98201 CHNCELLED BV THE CITY UPON ANY STOPPAGE OF WOqK ON THIS <br /> Phone:259�8610 pROJECT OVER 90 DAYS DURATION. <br />