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Date � � <br />ApplicationFor TO POSTING <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />��� U � 1996 <br />� <br />PUEiic KorMs Vprmi� � Q; !�_ <br />. �, <br />oiae� oeo�. + _ <br />Puel¢ works Fee <br />Total Fee S <br />Less ApOI Fee PaiE S <br />�, <br />Balar.ce Due S � <br />LL�t�D Canstrucfion "LICH�7 - 4?th Dc SE Botheli, Wa 9F��)21 <br />Owner Maifing Addtess ; Ciry, _ � Zip � Phone <br />Applicant <br />Describe Proposed Work <br />House ��°9 <br />�.':.�� :. . <br />City <br />o a o owdermili Highlands Dw!sion 2 _�� <br />- re�TSVO -- <br />Project Address (if known) <br />Attach four �3) copies of plans for proposed work - Drew to scale and note �h� foliowing as applicable: <br />• Property Line . • Centerline of street <br />• Outtine and dim�nsions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor Inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be perfo•med in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specificat(ons. <br />3. Call Location Underground Service 48 hrs, before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />�. Keep city streels clean nt a0 times. <br />5. Cmb gulicr m�d sidaw;ilk a� thz piat .ue uew ;uid undmnagad, auy dama�C Qldfdl0 SI18I1 �C CC�)h�ccd ai qie <br />discretion ofthe Fublic Works Inspector. <br />ti. My chanee in thz driveway cut must be approved bY fhe FW Tnspcctor, width at prop W�e 6mited to <br />cxisting apron width. <br />?. Adjust water boxes to ,v,radc at cud of constntcfion. <br />8. Dnveways shall be completety cured before Jmv�g on tLem. <br />9. FooRop cL�ainage sh�ill be dischargeJ: <br />• to the site's sromi �lrain .rystem (private or public) <br />' IO 81':•911IC011:1I f00P1I0W11S�)011i Sj���Clll (ICSI(�'lICO �)CI' Shc'IIOR ti•�i.� OPUIC l'lly 5�8fI1I71:(IS <br />• outo splash blocl:a <br />Phe rnethod selected will be s;i�ject to Yubiic Works llepsi7tment arpsoval. <br />-,f�� �_� �- -7 /-� �1_ <br />Approved 'or Construction Date <br />t / / <br />_i�-� ���•i�F%/ � �'..tG.�lE <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />�A��PUBLIGWORKSDEPARTMENT <br />3200 Cedar Street <br />Everett, WA 9B2U7 <br />Phone:259-BB10 <br />ACKNOWLF�rEMENT Of CO� IDITIONS <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned c:�ner/a;�r.iica�t hereby agrees to hold antl save harm- <br />less the City of F:vereL f�om any and all claims for damages, costs, <br />expenses, or causes of a.ction thai may arisv Gecause of inr,lallatior <br />and maintenance of the imorovem�dnt or other rightrof•way use hereto <br />applied for an� further agrees to remove same upon notice from the <br />City and to replace public prcGerty damageA thereby. <br />��i� .- � �-�� �-_ 9�i/y3•- <br />S aWre oY, �pl�cant "T-�Date <br />WGR�( AUTH RIZEi) BY THIS PERMIT MUST BE STARTED WITHIN <br />780 UAYS GF DATE PERMIT IS ISSU[D AND THEREAFTER IS TO <br />BE DILIGENTLY PUFl2il�ED TU COMPLET�ON. THIS PERMIT MAY BE <br />CANCFLLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT' �:'SR 90 DAYS DURATION. <br />