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1 <br /> � �' <br /> �3 <br /> t" �� y _ . .. <br /> I <br /> H �t � <br /> ky � � O <br /> '9 H Date-���l-`:"! P��m��wo,wsvwm�n. _ /� —� , <br /> � y �i � � ApplicationFor TO PQSSI��G � Q� no�m • ��> r� �g <br /> � e PUBLIC WORKS PERMIT P��°"`w°��"" <br /> .o„���� s_—. <br /> H <br /> �ess anoi Fee Pau1 S--U <br /> � �g �, � <br /> t�1 o,i,���o�� 5 �•�O .— <br /> a H� Print or Type Only <br /> ty H �y <br /> �- y ,I A� ���•h,1't S��tN� ia � 5�f ,�a i�_ <br /> v� Ge.nn���rr, �l�i �y 't�-- � ZiP� Phore <br /> ~ Owner Mading Address Ci�y <br /> �C!�Vi <br /> �y � AUP� '���y�� Mailing Address City ZiF Phone ,' <br /> ... . � . . Describa Frcposed Work �..Qs�_��`� ^ 'P FG r..�,� �Pfd 1]�'�.� �riT (_I �N �/�i� /(L <br /> J—` —T � <br /> -__ W <br /> Pmiecl Address lif knownl _ 9g I -rj 2�{-{_L, Or ,5� -- � <br /> Attach tnur(A)copies o� p��ns foi propesed�vork� Ora�v to scale and no�e the followin3 as applicable: �I <br /> • Property Lines • Conterline ot street � <br /> • Outline anC Aimensions o�all eaisting and • InJicate NorGi <br /> proposed structures on IP. ot • Show any proposed groding changes <br /> • Existing and proposed utiiitiec • Show measurement�. /1A . <br /> W <br /> / '�1 '.:i0 NOT WRITE BELOW THIS LINE O � <br /> 1 � PERMIT COM1DITIONS <br /> � 1.AI!calls br inspection shall be made 24 hrs.in ad�•ance�phone 259-8810. � <br /> '�' 2.All work shall be pedormed in aocordanc?with this pernit and current City of Everett Design and Censiruction <br /> Stantlai�ls and Specitications. <br /> ' ' 3.Call Loca�ion Underground Service 48 hr,befure you c•g.TOLL FREE NUMBER 1•800-424•5555. � <br /> � 4. Iasueance of all sub:<Pquen`. permits in *•he Gutherie <br /> � Pl.ats canuitioned upoci ^eonarco providing the city a , <br /> �1 $5000 street cleaning performance t�ei;-aside letter. O I <br /> ' 5. Keep city straetrt clean at all times. � ' <br /> � 6. Curb, gutter and aidew�lk in the plac are new and � <br /> ��� undamaged, �ny r�amage thereto shall be repl.aced at the � <br /> diecretion of the PuUlic Works Inspertor_ � <br /> 7 . An,y change .in the dri.vewoy cut musY be apprc•.•ed by the O <br /> '`''� Public Works Inspector. ' <br /> �1 ? Downspouta and yard drains shall be tightlined via pvc � I <br /> ' to pi�Ulic drai.nage sysY.em. � <br /> 9. Adjust water boxea to grade at end of conetruction. i <br /> 7.G. Driveways ahal.l be completely cured before driving on <br /> '�' them. <br /> ' LZ � , _ _ ACKNOWLEDGEMENT OF CON�ITIONS <br /> �r_' � The undersi9ned ownedapplicant hereby agrees to hold and save h'�nn� <br /> �-�� less the City ol Everet! from any and all claims tor dama9es. wsts. <br /> � ��� expenses. or causes of action that may arise 6ecause ol installation <br /> /�.�F 9/ and maintenance ol the i9 provement m other righFof-waY use hereto I <br /> —`—!� applied for �y7 f�riher a rees to remove same upon notice Irom Ihe � <br /> Approved�Cons uction ' D3te City an o r Qlace pMblic property damagetl thereby. <br /> � � f <br /> k/_/s'�r—�-/%; �� ''-�- _ ';�-=�- � `/'��'.v��' �� � <br /> FINFt IiVSPEC`IO"J�- � ` � bate � " � i ' Date , <br /> Anp��oved as Consiructcd ignature cf policant <br /> WORK AUTHURIZED BY THIS PERMIT MUST BE STARTED WIiHI�! � <br /> �everett PUPUC WORKS DEPARTMENT 180 DAYS OF DATE PFRMIT IS ISSUED AND THEFiEAFTER IS TO I <br /> � 32nOCedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT NAY BE <br /> Evere!!,WA 98201 CINCELLED BY THE CITY UPON ANY SiOPPf GE OF WORK ON THIS <br /> Phc.•,e:259-8810 PROJECT OVER 90 DAYS DURATION. <br /> J <br />