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�8ie�i- ��� r � <br /> (lC'� PUEIm WorFs Perm a �� <br /> `. � <br /> Application For BIEB.DeO�.�_ � <br /> PUBLIC WORKS PERMIT PueTo!alFee�ee $ <br /> Less ApPL Fee Paia �> <br /> Print or Type Only BalznceDue S '7—��r _ <br /> I <br /> ` i <br /> �_ ��.lF=��r`' �!,�^�il��� /�' i�r.X ���R I���C�iI��P� ���75 �7-�l �- I <br /> Owner Mading Address City Zip Phone <br /> Il i� <br /> Applicanl Mailing Address City Zip Phone � <br /> Describe Proposed Work — ���^-� �.���� / I ����( ��� (U .����1� 1 /��_\� <br /> �� � � �� <br /> _ -- � <br /> ProjectAdd�ess(itknown� 100I — 4�� P�-AC.0 � �,.�, � <br /> Attach four(4) copies of plans (or proposed work- Draw to scale and note the lollowing as applicable: � <br /> �. • Properry Lines • Centerline ot street � <br /> � • Outline and dimensions of all existing and • Indicate North <br /> proposed sfructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � , <br /> DO NOT WRITE BELOW THIS LINE j <br /> I <br /> PERMIT CONDITIONS I <br /> 1.htl cells for inspection shall be made 24 hrs.in advance•phone 259•8810. � � <br /> 2.All work shail be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you di9.TOLL FREE NUMBER 1-800•424-5555. � � <br /> 4.ANY CHANG6 IN THS DRIVEWAY CUT MUST B� APPROVED O <br /> BY THB PUBLIC WORRS INSPBCTOR. <br /> 5 .CONNSCT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTSM. <br /> 6 .R6SP CITY ST�2SSTS CLSAN AT ALL TIMBS. � <br /> 7 .ANY DAMAGS TO THB CURB AND SIDLWALR WILL BE REPAIRSD � <br /> TO '!HE SATISFACTION OF THE PUBLIC WORRS DEPT. <br /> O <br /> a <br /> ti � <br /> h ACKNOWLEDGEMENT OF CONDITIONS <br /> �� The undersig�ed owner/applicant hereby agi ��� !o hold and save harm- �� <br /> less the Cily ol Everett irom any and all ci3;�; for damages, costs. <br /> A expenses, or causes of action that may a��se b��cause of installation <br /> �C,,,, (] �'�r IG� G / / /6:� and maintenance of Ihe improvement or otner righbof�way use hereto � <br /> �� � � '�v applied for and luriher agrees to remove same upon notice from ihe <br /> Approved tor Conslruction —aa�F City�p d to re'{�lace public properry damage� thereby. <br /> ��n�� � �1 r 9/ �c�Gf' t'd''�yYlGq n <br /> �A / C ,L a <br /> FINALINSPECTION Datr:^ 4- � /�( /� <br /> Approved a�Constructed Signature ol Applic� `�� J Date <br /> everett PUBLICWORKSDEPARTMENT WORK AU7110RIZED BY THIS PERMIT MUST BE STARTED Y4ITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTE(i IS TO <br /> Everett,WA9B201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Phone:259•8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUFiATION. <br /> I <br /> I <br /> I. <br />