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7/26/8J vcm�ce:oiksaermn< �•3 '1 <br /> DeIB 91EB�DeO��• 83/12267 <br /> Applica�ion For <br /> PUBL.IC WORKS PERMIT PUbTotlFeaFee g �o��, � <br /> Less AOG��Poe Paid S ll T <br /> BalancaUuo � �' v V <br /> Print or Typa Only <br /> Hillic Homes Inc. 826 S.E. Everett Mall t9ay Everett 98204 355-4492 <br /> Uwner MaAing Address Ciry Zip Phone <br /> Same <br /> Applicanl Mailing Address Cily Zip Phone <br /> 67 Instal]. 25' Wide Concrete Driveway <br /> Describe Propos�d Work <br /> W <br /> Projecl Address(if known) <br /> .{o. l '� C'fa�Pv� e Wa S, w . Lot iaa �.. <br /> � <br /> Attach iou:1a) copies ol pl��s for proposed work- Draw to scale and nole�he following as applicable: � <br /> • Property Lines • Centerline ol streal <br /> • Oulline and dir,iensions ol all existing and � Indicate Norlh <br /> proposed sirucWres on ihe lot • Show any rnoposed grading changes <br /> • Ezisting and proposed utilities S Show measuremenls M <br /> W <br /> ��� DO NOT WRITE BELOW THIS LINE � <br /> PERMIT COND�TIONS <br /> 7. ,411 calls lor inspection shall be made 24 hrs. in advan�e- phone 259•881 5. � <br /> ?. All work shall be perlor�ed in actordance with this permit and current Cily of Everelt Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigiied�wner/applicant hereby agrees to hold and save harm� <br /> — — — less tl�e City �:f Everett Irom any and all claims tor damages, costs, <br /> � � , �• enpenses, or causes of 3ction that may arise because ol installalion <br /> and maintenance ol ihe improvement or olher right�of�way use hereto <br /> �j �3 �p¢fie, and luriher agrees to remove same upon nolice from the <br /> Approved for nst tion �a�e i City and t replace public properly damaged ihereby. � � <br /> / /� <br /> � � 1 � � �s - y�; � ,�— CY�� ;' <br /> FINAL INSPEC7iON Dalc �� � - / � Date <br /> Apnrovetl as Constru:ted Sig ture ol Appllc .t � <br /> WORK AUTFIORIZ D BY THIS PERMIT MUST BE ST'.RTED WITfiIN <br /> evemtt PUBLIC WORKS DEPARTMENT �g0 DAYS OF DATE PERMIT IS ISSUED AND THEAEAFTER IS TO <br /> � 3200 CPd.r Streel BE DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY EE <br /> Everett,WA 98201 CANCELLED OY THE CIT1'UPON ANY STOPPAGE OF\NORK ON THIS <br /> Phone: 259�8815 PROJECT OVEP 90 DAYS DUHATION. <br />