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Date�Q I ' <br /> � TO POSTING Pu0licWorhnPermilN �i �; � <br /> Application For emo.oAo�.+ <br /> PUBLIC WORKS PERMIT PublicWorkeFee -- <br /> To�.�Fae s <br /> Leae I,ppt Fee PaiC � <br /> Print or Type Only e��a..�a o�a s Z-CY"' <br />, _t ' PdrlPflr) �%/��' /�/ `�yk�.1r JPr� TT�e 7 U �d � �i '�) �'�!3 <br /> Owner MaiHng Address Ciry Zip Phone <br /> jS�ru�L �e �r ��Ylt�rrrn� oZSci-oZS/S�— <br /> I Applicant Mailing Address City Zip P ne <br /> I Describe P�oposed Work Nj'n C ..I �a ia. . ,� ��j�� <br /> �i4 - z� th oess - W <br /> I �,' �''��' Project Address(if known) T � � � <br /> I , 1` <br />� i�; '-'��' Attach four(4)copies of plans for proposed work- Draw to scale and note the followinc;as applicable: <br />: �:� . � <br />�, ��, , � . • Property Lines • Centeriine of shaet � <br />' " � • Outline and dimensions of all existing and � Indicate North <br />> -��:�"��- p�oposed sir�ctcres on ihe lot • Show any proposed grading chenges <br />� '-��"�. • Existh�g and proposed utllities • Show measuremenis <br /> . �'��`'� � � <br /> � <br /> � DO NOT WRITE BELOW THIS LINE <br /> PERMIT�ONDITIONS O <br /> . 1.All calh�.for inapection shall be made 24 hrs.in advanca-phone 259•8810. � <br /> . 2.All woM shall be performed in accordance with this pe�mit and cunent City of Everett Design and Conatruction <br /> Standaras and Speciflcatio�s. <br /> 3.Call Locatlon Underground:iervice 48 hre.betore you dig.TOLL FREE NUMBER 1•800-4245$55. � <br /> 4_ Iiustall roclt conatruction entr.en;,e beh3nd drfve�rsy aa <br /> . �per oity atandard it208 to e1L�inate trac�ing wd onto O <br /> atreeta ae directed by Public i�lor�e Inapector_ <br /> 5- Heep city etreete clean at all ti�ee. <br /> 8- �rb, gutter and eidaNalk in tha plat are n�nr and � <br /> unae�nBed. anY dem�e thereto ehall be replaced at txse <br /> dieQretion of the Public Works Inepector. �/� <br /> 7- Any change in the drivevay cut iuet be approved by tha ��� <br /> Publiv Worke Inepactor. O <br /> 8_ Tightline a12 roof, qard and drivevay drz•aine fra� <br /> houees to C.B_ etube at bacY of eide ralk vith rubber a <br /> gae�at P_V.C. pipe <br /> 9. Ad,iust water boaee to grade at e�nd of conetruction. <br /> 10. Drivenaya ehall be conpletelq cured before driving on <br /> �� I thN_ ACKNOWLEDGEMENT OF CONDITIONS <br /> (f/ The undersigned cwner/applicant hereby agrees to hold and save harm• <br /> � less ihe City of Everett from any and all claims for damages, costs, <br /> ezpenses, or causes of action that may arise because of installation <br /> ��Q m�K� �_ f I� � • ��:c �naintenance of the improvement or other right-of•way use hereto <br /> Approve tor Construction <br /> an?!�ad for and furthe� agrees to remove same upon notice from the <br /> �,_ Date ;ity a�id to replace public property damaged thereby. <br /> FI LINSPE O �• �� � y� � � fd'���/..'9"` � ,7 4 <br /> i � f.., i <br /> 4pproved as Constructed Signature of Applicant ate <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE ST TED WITHIN <br /> � 3200CedarSt�eet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT tAAY BE <br /> Phone:259-8870 CANCELLED 6Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />