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� <br />TYPE OR PRINT ONLY <br />Appliwtion For <br />PUBLIC WnRK.S PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA 98201 259-8810 <br />'"'� �'Q5TING ocr r �_ <br />oate 8/30/96 _ <br />Public Works Pertnil t! /� 3 L3 <br />BuildingPermitk 5�]5j <br />Public Works Fee $ �d <br />Applicant Mailing Address City 2ip Phone �� <br />Describe Proposed Work <br />PROJECT ADDRESS (:f known) <br />3✓rj Or. � <br />Attach lour (4) copies of plans lor proposea work - Draw to scale and note the following it applicable: / <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on Ihe lot •Existing and p��Bes <br />•Centedine of sireet •Indicnie North •Show any proposed grading changes •Show measuremenis E�.DG 5706.� <br />DO NOT WRITE BELOW THIS LINE �CH 560.00 <br />PERMIT CONDITIONS: SRCHRG 44.50 <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. p�Z� �' q�0. pp <br />2. All work shall be pertormed in accordance with this permit and current City of F���ti�DesigQ-Qr�d <br />Construction Standards and Specifications. 0 9094 <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM�� 800��5. <br />q00030794 <br />1. Ins�all ruck construcliou enlraner belond dm:w;ry as per cily slandard !l203 ancSENE�on cmPfi�FQOdirected <br />PuLlic Works 6ispec�o�. S5'SDEV 4:29b,00 <br />5. Kcrp cify �Irt:ls cic:m a� all timcs. CHECK 4�350.1J <br />G. Curb gutler and sidew;ilk in ihe plat arc nev� a��d undamatled, airy damage Ihereto shal! bc replaccd al the <br />disnetion ol tlie Public Works Inspector. <br />1m� changc in the drivewap cut nmst be approvcd by the P1u In�peclor, «�dfh .il prop lin: limitcd (n c�sfiu <br />apiou widtli. <br />ti. Curb faee drain� or otlar slonu �Iriiu ;iu!r; h;ir; b�•:u pr���id rd io cadi lot in ili. pl:u i,n Ih� i� ,�u, diou of <br />rnnOn�, doampoutc <br />_�� <br />ACK��WLE�GEMENT OF CONDITIONS <br />The undersigned owner/applicant here6y agrees to hold and save harmless <br />the City of Everett Irom any and all claims for damages, costs, enpenses, or <br />causes of action that may arise because of installation and maimenance of <br />Ihe improvement or other ngM-of-way use here'o applieA tor and furlher agrees <br />tc remove same upon notice tmm the City antl to replace pu6lic property <br />damaged thereby. <br />y i <br />iL'e ^ ..G � 'j <br />Signature of Applic nt Dato <br />WORK AUTHORIZED BY TNIS PERMIT A11!ST BE STARTED WITHIN 180 DAYS OF DATE PFRMIT IS ISSUED A D THEREAFTER IS TO BE DILIGENTLY PU�7SUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORfC ON THIS PROJECT OVER 90 DAYS DURATION. <br />