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-- 4�3� � <br /> Date�L: �� f (� q P��I¢WO�ka Petm��• ��/� ' <br /> Tl, pQSY�NV J'74-A `� eiaeoeo� • 4725Z <br /> qpptication For � <br /> PUBLIC WORKS PERMIT '°°"""°`"'°`° <br /> Tolel Fee s <br /> Less/00��Fee Pa�E S <br /> Balance Due s � 0 <br /> Print or Type Only <br /> � <br /> - � 237 E�m �tX� ��� \�/ri _9'PJ203 ZSE�-15�3 � <br /> ��� �r�.•_ ZiP Phone <br /> Owner Mai4ing Atldress City <br /> Applicant Mailing Address City Zip Phone � <br /> p�� G <br /> Describe Proposed Work New 5i I C�G9 �T�m• � !�'�'�� -�' <br /> W <br /> Prolect Address(il known) S�Z� ^ � ✓��VG V✓GS'� � <br /> Attach four(4)copies ol plans for proposed work• Draw tc scale antl note Ihe following as applicable: � <br /> • Property Lines • Centerline of sireel � <br /> • Outline and tlimensions ol all ezisting and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All cells for inspectlon ahell be mede 24 hrs.in advance•phone 259•8810. <br /> � 2.All work shall be peAormad in eccordence with this permit end current City of Everett Design and Construction <br /> Stendards en9 Specifications. � <br /> 3.Cell Laalion Undarground Service 48 hrs.before you dig.TOLL FREE NUMBER 7•800�4245555. <br /> 4. Install rock r_onstruction entrance behind driveway as per city O <br /> standard #208 and erosion control as directed by Public Works <br /> Inspector. <br /> 5. Keep city streets clean at all times � <br /> 6. Curb gutter and sidewalk in the plat are new and undamaged, <br /> any damage thereto shall be replaced at the discretion of the � <br /> Public Works Inspector. <br /> 7. Any change in the driveway cut must be approved by the PW In- O <br /> spector, width at prup line limited to existin� apron width. <br /> 8. Connect all roo£, yard and driv�eway drairis to storm drain � <br /> system provided to lot. <br /> 9. Adjust water boxes to grade at end of construction. <br /> 10. Driveways shall be rompletely cured before driving on them. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereUy agrees to hold and save harm• <br /> less the City ol liverett trom any and all claims lor damages, costs, <br /> expenses, or causes of aclion that may arise because ot installatinn <br /> �V-" O-( ZS '�3 and maintenance of Ihe impro ement or other right�of-way use hereto <br /> «��� ���� applied for and h�rther ag s to remove same upon nctice irom the <br /> Appr ved for Co sVuction Date �;ry nd to r plat��P��^ oR( PQ��Y damaged thereby. <br /> � �jr�r� e�{'t,�/ <br /> c�-.�% 3 8 ��Y /',. /1,�/e � �-3--q 3 <br /> FINAL INSPECTION Date �q--�=�� 'AA" <br /> Approved as Consirucled <br /> �ignatlire ol APplica Dale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �Ar� PUBLICWORKSDEPARTMENT 1B0 D�YS OF DATE PEIlM1T IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar.^,ireet BE DII.IGENT�Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />