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� <br /> i.�-90 = <br /> Date /Z�+ � , - <br /> Pu�l2 Wods Pe'mil a �� <br /> r�i Applicalion For Bmp.Dept n �� <br /> PU�.IC WORKS PERMIT P����<Wo�.,��o <br /> diolal fpe � <br /> O <br /> Less ApPI.Fee Paid $ <br /> Print or T e Onl � � " ��"�' 4 � � o �� 2�— <br /> yp y"� 3' O Ow0 O • • • f3alan<e0ue J <br /> O V�) W .-�-ei bi f.l vJ M�, � .-� [� <br /> 1 � p� b� b� U1 W 4l .-1 OJ L� <br /> �.J N � 1 �a U� Ui �-1 <br /> - C'�.8 �''� � �.����vl 9���—�y -�s��,� <br /> Owner ,� o � r� yA��c��l�;w ,� c;� Gry L <br /> �•� o o u� c� u� �- 0 3 P Phone <br /> � o » w ;� `c�g� o �!y� � .�-� x <br /> � �L O] 2 X iil O ai 7e i$ .-� t� <br /> Applicant Mailing Address Ci�y <br /> Z�P Phone <br /> Describe Proposed Work _ / F-�/�j ��� /�t_�G RJ�„���,._ ,,,_r,� <br /> �-�...��.-��7-.j�� � =%c r r I � <br /> — II���-L ;� <br /> ProjectAddress(if known) _�_�-�p " �.14� L71Z, S� � <br /> Attach tour(4) copies of plens for proposetl work- Draw�o scale antl note thr. lollowing as applicable: � <br /> • Property Lines • Centedine ol sirPet <br /> • Outline and dimensions of all existing and • Indicate No�ih � <br /> proposed siruciwes on the lot • Show any proposetl gradmg chan,ns <br /> • Existing and proposed utildies • Show measuremcnts <br /> DO NOT WRIiE BELOW THIS LINE � <br /> PERMITCONDITIONS ^ <br /> 1.All cells for inspection shall be made 24 hrs.in advance-phone 259•88I0. `� <br /> 2.All work shall be peAormed in accordance with ihis permit and current City oi Everett Cesign and Consiruction �' <br /> Stendards and Specifications. <br /> 3.Call Location Underground Service q8 hrs.before you dig.TOIL FREE NUMBER 1-800•424-5555. <br /> � <br /> O <br /> 4.ANY CHANGfi IN THfi DRIVEWAY CUT MUST BE APPROVfiD � <br /> BY Tf� PUBLIC WORRS INSPECTOR. <br /> 5_CONNECT DOWNSPOUTS TO PUDLIC DRAINAGfi SYSTEM. � <br /> B.KFifiP CITY STRBfiTS CLfiAN AT ALL TIMSS. <br /> 7.ANY DAMAGP TO THE CURB AND SIDfiWALK WILL BE RPsPAIRFsD O <br /> TO THE SATISFACTION OF THE PUBLIC WOT2KS DEPT. <br /> , � <br /> a <br /> /�l� ACKNOWLEDGEMENTOF CONDITIONS <br /> The undersigned owner/applicent hereby agrees to hold and save har <br /> le;s the Cily ol Everetl Irom any and all claims lor damagt�. coe�. � <br /> �� ,e A C� expenses, or causes ol action that may ari,e because ol ins;allat. <br /> J�� � ' �^ �Q—g Q and maintenance ol the improvement or other right�ol�way use her <br /> Approved lor Construclion Dale applied lor and lurlher a�rees to remove same upon notice hom ihu <br /> / Cily a to replace p b�ropeny damaged Ihereby. <br /> �c�v<< L� 7 - / $'- 9� <br /> FINAI INSPECTION Date '�� <br /> Approved as Conslructed i alure D p cant � <br /> Date <br /> everett PUBLIC WORKSDEPARTMENT WO K AUTHOR ZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedorStreel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evereu,WA 98207 BE OILIGENTLY PURSUED TO CUMPLETION. THIS PEFMIT MAY BE <br /> Phone;259-8810 GANCELLED BY THE CITY UPON ANY STOPP�GE OF WOHK ON THIS <br /> PRO.!ECT OVER 90 DAYS DUFATION. <br />