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. ' <br /> � r � I <br /> � c <br /> Date ''> 1 ICi P,�o���v�a�k�P�,m��._ -� �7`L <br /> AppliCa�ion For emy.Deni.� �" "�- �� <br /> PUBLIC WORKS PERMIT P��bLCWmksFce i <br /> To�,�F�� s <br /> less Aoo�.Fee Pai� S i <br /> Print or Type Only er�,��,�o�e S �—�-� <br /> ,`"�'�=�lr'��� 7� r��'.`� �-�� ✓_'�r.;�' ' �:�,� 7�«�C'i�lf�F� ��-�7� �-�."l-�'1`7� <br /> Owner Mailing Address City Zip Phone <br /> « �� <br /> Applican� Mailing Address City Zip Phone <br /> Describe ProPosed Work � � �� � �1�� �Fr--.� �l' C �����j� �\��<.t l f �� ������'�l-� � �' <br /> � l � � � .� T�� I <br /> i <br /> _ W ,�� <br /> Projec�Address(if known) 101�j ���FF' �'Jl-AC..E 5�—( � � <br /> AttaCh four(4)copies of plans tor proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of sireet � <br /> 4 Oulline and dimensions oi all existing and • Indicate North <br /> proposed struc�ures on the lo� • Show any proposed grading changes <br /> • Existing and proposed utilities • SI•�ow measuremenfs � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance• phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications �� <br /> 3.Cali Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-SOO•424•5555. � I' <br /> 4 .ANY CHANGE IN THE DRIVEWAY CUT MUST BE APPROVED <br /> BY THE PUBLIC WORKS INSPECTOR. O I <br /> 5 .CONNECT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. � <br /> 6 .KESP CITY STREETS CLEAN AT ALL TIMHS. � ' <br /> 7 . ANY DAMHGE TO THE CURB AND SIDEWALR WILL BS REPAIRBD <br /> TO THE SATISFACTION OF THE PUBLIC WORRS DEPT. �/� <br /> \I r <br /> O <br /> a <br /> � <br /> � ° ACKNOWLEDGEMENT OF CONDITIONS <br /> ,�'�� <br /> � �� The undersigned owner/applicant hereby agrees to hold and save harm- <br /> ' less the City of Everett (rom any and all claims for damages, costs. <br /> �I � /1 ^n , e<penses, or causes of action that may anse because ol inslallation <br /> ��n . . 1/ V'UIC�( .,,� � � � ❑nd maintenance of lhe improvement or other right-ol-way use herelo <br /> k.l�X. I I �xx• epplied for and furiher a9rees to remove same upon notice Irom the <br /> Approved for Construction U.te ��ityq'2�'d}Q repl cej��blic prope damaged thei2by. <br /> �°� _.. /�—�� -%o �i�/�"V�J,"�/%'� ' (�� �/ <br /> FINAL WSPECTION Dale Ai(/�A �J'[,e ./�.- � / LrIGD _ <br /> Approved as Construdetl Si9na�u e ol Appli ant � Date <br /> everet[ PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE�STARTED VJITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERAfIT IdAY BC- <br /> Phone:2.59-8810 CANCELLED BY THE GITY UPGN ANY STOPPAGE OF WORK JN THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> l <br />