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Date� ' ./ p(� /. P����,�wo�k�r��m��. 91�� _ <br /> � �� fl)«�����,1 _ (� � ei000eoi..�����7J�—_ <br /> Applia�iion For <br />� ��� PUBLIC WORKS PERMIT � �°°��°,':°.�=F�° -- — � <br /> ��,�n�F�•� s <br /> Le55A.'.G� FCC PaW 5 <br />� l��Cri 9.�.,cce G��o S 2� --_ <br /> ayN Print or Type Only --'------ <br />'� rx <br /> Ha� <br /> y zH <br />� " y� __ GC�y,1er(U l�ll'� /v �`�'�'Sj Sc'aJfIP y�/D.� 5�1 �-,F� /3 <br /> � H� Owner 61ailinp Address Cily Zip Phune <br /> V1 H <br /> � r - <br /> � x� _ Jr�1E- _ <br /> yb �ppiicam IdaJmg Address Ciry Zip Phone <br /> � �� Desr,;ibe ProPosed Work _���!'i � S��7✓[y��R/y1,1��i�.�/�1.L�/LL2� — <br /> �V n <br /> xy� — ---- - ..._--- <br /> gN y -- _ -- - -- ------- <br /> ,� �ce =�<r��z sE W <br /> � d� -- / ��1/ --- - � <br /> � �� Frciec!Pddress lil '<nuwnl •r7`'�� �`�.J'"•'�'-'�'`'`" �� --- <br /> r— <br /> z H(q A.'.ach four(4) coPics ot plans lor pwP�.� . :�oiY.-Draw to seal�anU not�, tnn L�II��:siro�a,epph��hie �� <br /> H O� • Properly Llnes • Gonb.ri�.n•. ,.�I street � <br /> � • Outline and dm�en:�ons o1 all cxistmq:�nd • Ind�,.st�- Nnrih <br /> propo5ed S�mc�ures On Ihe IGI • Sno:o a��7 t��op,�se�1 9iatlinq ch:�9es <br /> • Exis�ing and proposed uhlih�s • Shov: m.c.�surr�nmt9 /�/� <br /> �� DG �OT 1'JFI1E EIEL04H TF115 LWE � II <br /> PERMIT CO�:DITIONS <br /> �r� 1.All calls lor mspecuon 5hall r:e inaoe 2A hrs.in ativance�phonc 25J-881 O. I <br /> �� 2.PII vio�k shail bR pi'dorm�d m.�ccor:fanr.e with ihi5 permit and cuneni City ol Evere�t Ges4n and Construction � <br /> Sla'dards and�pecilications � <br /> 3.Call Law�icn Underground Sernce�U hrs.before y:n�J��y.TULI Ff.FE NUMBER �-50�•424•S�J$5. � <br /> •"'a••' 9 _ IneY.a31 rock r..onPl:.ruction ent:•.snr.e behind driveway as <br /> �r.� per ciCy Ptandard �Y208 to elisi�iate ti•::cking mud onto O <br /> sY,reaY.e as d.irected i�y Pul�lic Works i:ispector. <br /> ,M y 5_ Reep citY at:reota clean at �11 t:imee_ <br /> � � 6_ Curh, ��tter and �idewal_k in Y.he pl.at are nes.� and L <br /> �"' undamaG?�1, �Y ��aP,P tl.iereto nhall be replaced at the r <br /> diacreCion of t}:e Public Worlca Inapoctor_ �^ <br /> �+� 7_ Any change 3n tha drivoway cut muat be approvec3 by t,he d�� <br /> ��,� R�bl i c Wnrkc� Ins�r,t:or_ o <br /> 8. 1'ightl..ine a]l. roof, yard and driveway drains £rom <br /> houaea to C_B_ at-uhe at back of Eide walk with rubbor a <br /> � a ( gasket. P_V_C_ pipe <br /> ..., ,,� <br /> 9_ Adjust waL-er boxoo to grade at end of construction_ <br /> 70. Drivewayr� �hall be complr.tely curcd before dr�-•�inf,; on <br /> L}lO4i_ AGKNOWLEDGEMFtJI U�CGNDITIONS <br /> �� <br /> /:'� /r,r� _ Thc unJorsiqnrA owner/apphCani horebY�"�9�^P-tO hnld antl save hanm <br /> =�—�---- --- — less the Ctly ol Everel� Irom any anef al! claims for damz�es, cosls. <br /> expenses. or causes of action that rnay anse becausc ol installalion <br /> �_ (1 VtA c {/_ Z_ l_ � anA mainier.ance o� �he imU�o��'ment or other ri9h�-of-way use hereto <br /> ��''x— �� �''�s�— _�_.� �pphod tor anc �uriher agraes to ramove same upon noiice Irom the <br /> f.pproveA'-r Cons;rucfio:i ��Ir• CitY anfl4o reY��ce P��61ic property dama9ed ihereby. <br /> i � <br /> � / i <br /> �s-��.. �/�> y;�if �� � ,=,�,� - � /j , , `, <br /> :_------ �� �%/�i�� s �/� / � <br /> FINAL INSPECTION � Dale , <br /> App�oved as Constructed � I iy�ature ef PP��E��t J ' Date <br /> WO(iK AUTI�IORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTIdENT 180 DAYS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSireei BE DILIGLNTLI' PURSUEU TO COMPLETION. 7NIS PERMIT MAY BE <br /> Everett,WA 9820/ CANCELLED BY THE CITY UPON�NY STOPPAGE OF WORK ON THIS <br /> !'hone:259�8870 PROJFCT OVER 90 DAYS DUf�ATION. <br /> n <br />