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Date�L3�l0 ��o�,�wo,�,N�,��. ��,�3� <br /> Application For Bitlg Depl.�_QO /�Sf./�-- <br /> PUBLIC WORKS PERMIT �'WlmWorbFee � -- <br /> ro�ai Pec s----- <br /> Less Anpl.Fee Pnd S_ — <br /> paiancc Dve S ZC� <br /> Print or Type Only — <br /> G)r,�ll,��n., l�irts�.t l�G, '�x /� �Tsi�'G�/A 9,fo�/ti S�/G - 3y'(2� <br /> Owner Ma�iing Aadress C�ty Zip Phone <br /> C, <br /> l�I7'� ��l' <br /> ^ Applicant Mailing Atldress City Zip Phone - ��- <br /> n r �p �"� �, <br /> Describe Proposed Work �J � � ��il.rT�p ,{a ��f1�J �LCe/�L �-o � y�� _ <br /> - W <br /> Prolect Address(il known) ���'� — Z' N t� ��Z. S� � <br /> Attach tour(4)copies of plans lor proposed work- Draw to scale and note lhe lotlowing as applicable: � <br /> • Property Lines • Cented:ne ol street 09/1B/90 1��59FM OOORk3713 <br /> • Outline and dimensions ol all ezisting and • Indicate Norih / <br /> propos^d siructuras on the lot • Show any proposed gradi��fg <br /> • Existiny and proposed utililies • Show measuremeNs �� �1�87 � <br /> DO NOT WRITE BELOW TViIS LINE • O <br /> �� �.� <br /> PERMITCONDITIONS B $RCH �R.S�O <br /> i.All cells lor inspection shall be made 24 hrs.in advance-phone 259•8810. �J � � <br /> 2.All work shell be pedormed in acwrdance with this permit and current City ol Everett Designari3Cqg�ru�clion� <br /> Standards end Specilications. �wu <br /> 3.Call Lxation Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-��Y��55=30•� � <br /> �� r sio.00 <br /> 1171-5 4650.00 O <br /> 4.ANY CHANGS IN THE DRIVEWAY CUT MUST BE APPROVED �7� <br /> BY THG P[IBLIC WORKS INSPECTOR. MRTER SS0.00 <br /> 5.CONNECT DOWNSPOUTS TO PUBLIC DRAINAGE SY3TEM. �Z7933 � <br /> 8.KfifiP CITY STRfiETS CLSAN AT ALL TIMES. BND I s100.00 <br /> 7.ANY DAMAGfi TO THS CURB AND SIDEGIALK WILL HE REPAIRED �E� 51556.37 //� <br /> TO THE SATISFACTION OF THF, PUBLIC WORKS DEPT. V� <br /> O <br /> a <br /> ��� ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apPlican�hereby agrees tc hold and save harm� <br /> less the Cily o� Everett from any and all claims for damages, costs, <br /> expenses, or causes of action Ihat may arise because of installation <br /> �,r�,��,� •7_ 79� and maintenance ol the improvement or other right�ol�way use hereto <br /> applied for and lurther agrees to removr same upon notice Irom Ihe <br /> Approved lor Const c �on Date Ciry and to replace public prope�ty damaged thereby. <br /> / <br /> ��lf- '-'s' s' ,��?..�;�' G�!�,,�.� 5/,b-/s� <br /> FINAL INSPECTION Date <br /> Approv as Construcled SignaWre ol Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHOFIZED BY THIS PERPd1T MUST BE ST.4RTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSI.-D AND THERE�FTFR IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE C:f1'UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DJRATION. <br />