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_ i <br /> , <br /> Date�'�` 1(� CL�... ' <br /> Puol¢WorASPer ��•�� <br /> /� ' l� C�l <br /> Application Fo� oieq.oeni.._'�C � � � <br /> PUBLIC WORKS PERMIT PU�TolTlfee`Ce � i <br /> Le5sAo01 fcePd�tl S I <br /> Print or Type Only e,�a�«o�„ g �-�9— <br /> _`��IU'�'-t- .�1, ��;► � �"<�. .I-�, 1�,,�X '�71�,� 1�����C�Si �'f�'�T� �i�Y��� ��-7 `�I��-, <br /> Mailing Address City Zip Phone <br /> 6l f\ <br /> Applicant Mailin9 Address <br /> CitY Zip Phone <br /> Describe Propcsed Work ��( �� -� �� � � � � �(`�'� � �_1 i�- -�"LT I ��i>�,� ���ij����:� �� <br /> — f �,1 )�1 I �� � ��� <br /> Project Add�ess lif known) �2� — --y `�I'1'� PL 5 l.� � <br /> Adach four(4) copies of plans lor proposed work� Draw to scale and note the following as applicableOS/LS/9O 12=�.7°I� OOOANiS?S � <br /> • Property Lines • Centerline ol streel / � <br /> • Outline and dimensions of all existing and • Indicate Nor�h � <br /> proposed structures on the lot • Show an #O�Oc3801 <br /> • Existing and proposed utilities Y P�oposed gratli�y�,�panges$504.50 <br /> • Sho�v measurements w <br /> FLFG 560:00 M <br /> DO NOT WRITE BELOW THIS LINE Y��� <br /> PERMITCONDITIONS E SRCH $4.50 O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. DRVW�1 $�0.00 <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Desi b000"�o8flr � , <br /> Standards and Specifications. � s� ����0 <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-$00•�7j.�55�650.00 <br /> ewo r szio.00 Z <br /> 4. ANY CHANGE IN THE DftIVEWAY CUT MUST BE APPROVED ��06761 O <br /> BY THS PUBLIC WORKS INSPHCTOR. WATEn. 5b0.00 <br /> 5 . CONNECT DUWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. q00023858 <br /> 6.KEEP CITY STRBETS CLEAN AT ALG TIMES. ELpG 5576.SD � <br /> 7 .ANY DAMAGE TO THE CURB AND SIDEWALR WILL BE REPA�D $k5.00 <br /> TO THE SATI�FACTION OF THG PUBLIC WORRS DGPT. �90.00 � <br /> PLN CH 53�.17 <br /> E SF.CH 54.50 O <br /> DF:UW�t 520.00 <br /> WRTE�' 260.00 � <br /> HOOOL7JS� <br /> SEWEF': �30.00 <br /> � 1171-5 5650.Cn0n <br /> 1` 1�� ACKNOWLED(�,��1 J.JTOI�CQ�q'�IONS <br /> � �;rih��i, 4,314'( 1"7 <br /> The undersigned owner/applican ereby agrees to hold and save harm- <br /> less Ihe Gty ol Everett Irom any and all claims for damages. costs. <br /> expenses, or causes ot action �hat may arise because of installation <br /> jj � �G� Z,/� /C� and maintenance of the improvement or o�her right-of-way use he:e�o <br /> Approved lor onstruction .- Date applied tor and further a�rees to remov same upon notice Irom the <br /> Q � ///.�' ,.. � Ci and to replace publ�c property da ged hereby. <br /> .C��—� �/ � –iv <br /> FINAL INSPECTION Date S � �fQ <br /> Approved as Construcled ic�nature ol Applicant a1e <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phoiie:259�88t0 CANCEL�ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVL'" ',� DAYS DURATION. <br />