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� � <br /> Dete 5-24-90 a�m��w„�s•-„•��. `Jd/2�C�— <br /> °' eiaa.oeoi.:_90/29694 <br /> � Application FOr — <br /> PU�IC WORKS PERMIT P�blicWoksFce <br /> iolai Fee $ <br /> � O O O ti O p O p p p 'y Lese A00��Fee Pa�O $ <br /> x- o 00 �Y' NU O O b00� � <br /> Print or T e Onl Ilf�] Baiance Due s <br /> YP Y rvior� �� o 0 000c� <br /> � �O [� U N uT C.l �O M .-i 1!] [+l <br /> .-� VJ N W u} W aa ur -y �l1 �O <br /> ,+ tl� tll i1i N <br /> O� e-I � Ul <br /> � <br /> Ia Rock Ho � � v 165�5 - �lstg-'Ave-+9B Hothell 98012 485-5030 <br /> Owner o o � co xMaJ � o w r:� Ciry 2ip Phone <br /> � oowc+ — cn > o �- o tnNw <br /> � � w a � rJimoaisui� m � � <br /> Owner � <br /> Applicant Mailing Address City Zip Phone <br /> DescribeProposeAWork _ Nnw Sinqia Famil� ur,�;AP.,r.A <br /> Project Address li� known) �t 43 - R1dq0WOOd TeZIdCO o 3G 1 - z�., � c�.��c .S�_ � <br /> � <br /> Attach lour(4) copies ol plans for proposed work- Draw to scale and note ihe following as applicable: � <br /> • Properry�ines • Centerline ol streei � <br /> • Outline and dimensions oi all existing antl • Indicale North <br /> proposed slructures on the lot • Show any proposed gradinc�chanyes <br /> • Existing and proposed utilities • Show measuremenl, � <br /> DO NOT WRITE BELO'�V THIS�INE O <br /> PERMIT CONDITIONS <br /> 7.All calls lor inspection shall be made 24 hrs.in advance-phone��9•8810. � <br /> 2.All work shall be performed in accordance with this permit and currtnt City of Everett Design and Construclion <br /> Standards and Specitications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREc NUMBER�-$�•424•$SSS. � <br /> � <br /> 4.ANY CHANGE IN THB DRIVEWAY CUT MUS" HE APPROVED � <br /> BY THH PUSLIC WORRS INSPHCTOR. �/� <br /> 5.CONNECT DOWNSPOUTS TO PUBLIC Ll2AINAGfi SYSTEM. �� <br /> 6.KEEP CITY STR6STS CLfiAN AT ALL TIMHS_ t, <br /> 7.ANY DAMAGH TO THfi CURB AND 5IDfiWALK WILL Sfi RfiPAIRED �� <br /> TO THE SATISFACTION OF THH PUBLIC WORIiS DEPT. a <br /> i <br /> � �_ � ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe Ciry ol Everett from any and all claims lor damages, costs, <br /> ezpenses, or causes ol action ihat may arise because ol insta�lation <br /> � C��+ � � — lO_� and maintenance ol ihe improvemen� or other right-ol-way use hereto <br /> applied lor and lurther agrees to remov= same upon notice from the <br /> Approved for Conslr ction ,i Dale City and to replace public properry damaged thereby. <br /> �/ / <br /> �. !(�"^"/�✓_ o-��1 � ��3/ �7� ,� (/ <br /> FINAL INSPECTION Date � " —`� �'�+�--� � �x0 '�"l� <br /> Approved as Constructed Signature ot Applicanl Da�e <br /> evcrett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PEPMIT MUST BE STARTED INITHIN <br /> � 3200CedarStreet 780 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA 98201 BE DILIGENTLY P:'RSUED TO COMPLETION. THIS PERMIT MAY 8[ <br /> Phone:259�8070 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PP7JECT OVER 90 DAYS DURATION. <br />