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3/15/93 <br />k - I �?,�' � <br />Date <br />PUBLIC WPOaRK� �F��� I�l 3 c <br />Print or Type Only <br />Same <br />Applicant <br />Describe Pr�posed Work <br />Project Address (if known) <br />Mailing <br />Mailing <br />New house Basic 167 <br />Zip <br />� <br />Atlach four (4) copies of plans for prc�osed work - Draw to scale and note �he fcllowing as applicable: <br />• Property Lines <br />• Outline and dimensions ot all existing and <br />proposed suuctures on the lot <br />• Existing and proposed utilities <br />PUEIic Works Permit ♦ O <br />eiag. oea�.. 3989 <br />Public Works Fee <br />TotalFee s _.. <br />Less Aoo�. fea PaiO S— � <br />Betance Due S �O <br />• Centerhne of slree� <br />• InJicate North <br />• Show any proposed gr.iding changes <br />• Show measurements <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8610. <br />2. All work shall be performed in accordance with this permit and current Cily of Everett Design and Consiruclion <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />Install rock conatruction entrance behind driveWay as per city <br />standard it208 and erosion control as directed by Public Works <br />Inspector. <br />5_ Keep city streets clean at <br />6. �rb gutter and sideWalk in <br />any damage thereto ahall be <br />Public Works Inspertar. <br />7. Any change in the driveway <br />spector, Width at prop lin <br />8. Connect all roof, yard and <br />11 timea <br />the plat are nes� and undamaged, <br />replared at the discretion of the <br />cut must be apFrwed by the PW In- <br />e limited to existing apron width. <br />dri.veaay drains to storm drain <br />system provid=d to lot. <br />9. Adjust water boxes to grarie at end of construrtion. <br />].0. Driveways ahall be completely cured I�fore driving on them. <br />���I�"IGf�X� n��l�v��3 <br />Approved for Consiructio Date <br />� �.,�� � // • 5' i� <br />FI INSPECTION Date <br />Approved as C�,naic��cted <br />�Ar�PUBLIC N'ORKS DEPARTMENT <br />� 3200 Cede r Sireet <br />Everett, W a 98201 <br />Phone: 25�`•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />J <br />� <br />� <br />L <br />N <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applican� herehy agrees to hold and save harm- <br />less ihe City of Everett irom any and all claims for damages, costs, <br />eapenses, or causes of action that may arise because of installation <br />and maintenance ot the improvement or other right-ohway use hereto <br />applieA for and turther agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />�GlLi L��L �/ ,/ �/%/ �� <br />Signature ol Applicanl <br />�'� � Date <br />WORK AUTHURIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1d0 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS �TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />