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11/30/9G �l- 'C:•79-h �7 . ' <br /> �a�e •� Puplic WoiFa Permil• <br /> App�ication For e�ao oeo� � 46334 <br /> c: <br /> PUBLIC WORKS P��iI�S�ING Pubh<WorMSFee <br /> �P ` C� p`. Totel Fee S <br /> 7 ll <br /> Lea6 Appl.F!e PaiE s <br /> r' S� <br /> Print orType Only r� '-� r� �� r� C:i C_� r� �-. o -9�ceDue <br /> �� r., r.i p r-� [� lrl r� ri Cr <br /> 'i d 0�. O. f,� rJ G �f 7 b O I^ p�. <br /> .. I .t .A �A `R � � eP- (.� M� <br /> William C Hayes PO Box 3561 9u203 1 2�-2946� �r �^ "� °' <br /> Owner Mailing Atldress n- `�� =o City c� -- :; P. . <br /> a .�: =t r, r.iZ�� iJ .r Phone <br /> vl C� L!r '�. �r lD :1. CL� S 7 O LLI O C'• <br /> p r.1 t 1 f� Ll f.i 7 C� � "I.� 1'� _. 4) W <br /> Same =� C� ..J !�) IJ J L.1 ._� �� ir ..f Cl ��1 . .1:. <br /> (1 ... .'� J_ Y-. fi. j� I fl t'� (' :3 bl il� r . <br /> Applicant Mailin,y Address City Zip Phone <br /> DesCribe Proposed Work — Np� hn cn <br /> Project Address�it known� 4822 Seahurst Ave � <br /> Attach four(4)copies of plans lor proposed work- Draw�o scale antl note the following as applicable: � <br /> • Propr,rty Lines • Cen�erline oi sireet � <br /> • Oulline and dimensions of all existing and • Indicate North <br /> proposed siructures on the lol • Show any proposed gr;ding changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All cells for inepection shatl be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shell be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standerds and Specilicetions. <br /> 3.Cal�Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. <br /> �t. R:�oflop cirainagc shall be discharged: Z <br /> • 1'o tltc sitc's stornt Jr:uii sysicm (privatc or public) O <br /> . Tu a resi�cnti�l roof duwnspuut system .lesigne�l per seclion 4- <br /> 9.�1 ol�lhe cilY sl.�i�lards �. <br /> . i-�nt�, splash blocks � <br /> The me�hc+d selected �vill he suhject to Pnblic Works Departement O <br /> approval. <br /> a <br /> ��� ACKNOWLEDGEMENT OF CONDITIONS <br /> \ The unde�signed owner/applicant hereby agrees to hold and save harm- <br /> less Ihe Cdy M Everett irom any and all claims lor damages, cosis. <br /> �/� 8/ eapenses, or causes of aclion iha� may arise because ol inslallation <br /> �/pp , and maintanan�e of the improvement or other right•of�way use hereto <br /> �'�� /� � applied inr and lu«her agrees lo remove same upon no�ice hom �he <br /> Approved lo,r�Co�n(s/jryction Date City and to replace public property damaged ihereby. <br /> /�"'�=�_ ` / <br /> r��Yr- � , ,/ <br /> FINALINSPECTION Date � ���� ��tv�-� <br /> ApproveA as Constructed S nature of ApPlicant Date <br /> �A�� PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT M ST BE STARTED WITHIN <br /> 3200CedarS�reet 180 DAYS OF DATE PERMIT IS iSSUED AND THE(iEAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />