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� <br /> � � <br /> Date�/� ! � pOSTiNG �- �� ' PubiicWorks�ermll•��?�Z�. <br /> � 3 <br /> Application For eiac.oau�.r <br /> PUBLIC WORKS PERMIT PublicWorkaFee - <br /> Total Fee $- <br /> � Less AOGI.Fee PeiE S <br /> Print or Type Only ea�e��e o�a _ S 70" <br /> �n�-r�/."�od NomeS t��l'IU P,�I-IZ� ��?d�Zct� �Ilcvu� 9f3a'�� (�-232� <br /> Owner Mailing Address City � . � Z�p Phone <br /> � <br /> Applicant Mailing Address City Zip Phone (` ,' I <br /> Descrl6e Proposed Work Yf�MsG l � ` <br /> s90 r _.. — W <br /> Project Address(if known) �f y���t ��G �� � �O�� �✓ '� n�a�r116vIJ5 � <br /> J <br /> Atlach four(4)copies of plans for proposed w�rk• Draw to scale and note the following as applica6le: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensiunc of all existing and � Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utii�ies . • Sh�w measwements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.All calls for Inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit end current City of Everett Design and Construrticn <br /> Stendards and Specificationa <br /> 3C I Lxation Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> 4�. �netall rock conatruri: 'on entrance behind driveway ae per city <br /> atandard #208 r�nd erosion control ae dir�cted by Public Worke � <br /> Inepector. <br /> 5. Reep city etreets clean at all timea <br /> 6_ Wrb gutter and eidewalk in the plat are new and undamaged, � <br /> any damage thereto ahall tr: replaced at the discretion of the <br /> Public Worka inepector. //\ <br /> 7. Any change in tha driveway cut muet be approved by the PW Zn— �/♦ <br /> spactor, width at prop line limitsd to exieting apron width. O <br /> 8_ Coxu►ect all roof, yard and driveway draina to atorm drain I <br /> syatem provided to lot. � <br /> 9. Ad,9uat water boxea to grade at end of conetruction_ <br /> .10. Drivaways ehall be completely cured before driving on them. <br /> ACKNOWLEDGEMENT(:� CONDITIONS <br /> ,��indersigned owner/applicant he�eby agre�s to hold and save harm- <br /> less tn� City of Everett trom any a�d all claims for d_�ages, cosis, <br /> expenses, �r causes ot ac�ion that • rise because of installation <br /> �I/1/�(�//�.,,,' �i , end maintt���ar'ca ot the improveme or o er right-ohway use hereto <br /> /L( 1.�(,�(.�'C' � applied tor an fun`�er agrees to r move me upon notice from the <br /> . Approved for C. nsVu ion a�e City and o rep a�e o i61ic pro erty mage thereby. <br /> f �,r, �f--� /'d .�a -�3 I \ I <br /> � FINAL INSPECTION Dale � � � <br /> Approved as Constructed gnature of Applicant Date <br /> /A� PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT S ISSUED AND THEREAFTER IS TO <br /> 3200 CedarStreet BE DILIGENTLY PURSUt-�TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 � CANCELLED BY THE CITV UPON ANY S70PPAGE 06 WORK ON THIS <br /> Phone:259•9810 PROJECT OVER 90 DAYS DURATION. <br />