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<br /> Date , uio� o�pi..�J �i
<br /> qpPlica�ion Far �F���___ , �'
<br /> �h� PU�L.':�� W�ORKS PERMIT '°�;�„����"° S - '
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<br /> y� --�1� � e Mrlmg Nddress City Zip Phone
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<br /> �"� Des.r�be Prop��ed Work �.f.(�-S1J)J �
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<br /> [�l y� Prolect Address lif known)
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<br /> AttacF�low l��) �opies ot plans Ur ProUosed woik� Dr.w io sr;;b, ,ind note tne IOILwIny as app�icabie �
<br /> • Property lines • CeMeriine of streM
<br /> • Outline anA dimensions ul ail exudng ,irtl • Intlic�rte North a
<br /> pwposed siructures on Ihe Ir,t • Shmv any proposed�r�diny r,�iar��7��s
<br /> • Exisliny antl proGos�•d uliti�n's O Shov:measu�r.ments /N
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<br /> � DO NOT:'JRITE BELOV•'THIS LIR:k �
<br /> '�'�' PERMIT GONDITIONS .
<br /> .,��� i.All calls lor inspection shall t�e made 24 hrs in ativance�phone 259•8810. �\
<br /> 2.All vrork shall be Pe�tormed in accordanca wi�h Ihis nermit and CurrcN Gty o�EvereL•Desiyn antl Construction �/
<br /> Standards and Specilications �
<br /> `ar a� � Call Location Undergiound Service 4B hrs.Uefore yeu dig.TOLL FREE NUMBER ?•800-424•5555.
<br /> .,,,,, ,,,�� 4 . In�tall rock construction entrance bahird driveway as
<br /> par city atandard #208 to eliminate tx•acking mud on�u �
<br /> streets as rected 6y Public Wurks Inspector.
<br /> 5. Keep ci.ty streeta clean at all times. �
<br /> '�"`� 6. CurL, gutter and sidewalk in t;�e p'.at are new and
<br /> w�damaged, any damage thereto 3ha11 bo replaced at the �
<br /> '.... ,,� discretion of tha PuUlic Woi•ks Inspoctor.
<br /> ,,,, ,,� 7 . Any chang� in the dri-veway cut muet Ue approved by the I �
<br /> PuUlic Wurks Inapector.
<br /> 8. T3ghtline all rouf, ya_,d und drivewaY drains from , _
<br /> huuses to C.B. stubs at back of side wellc with rubber �
<br /> .«' ^•tl gasltet P.V.C. pipe ,
<br /> 9. Adjur�t water boxes to grade at end of construction.
<br /> '... 10. Drivowaya shal.l Ue completely cured before driving on
<br /> �= �/,y �;}1CIlL �(;KNOWLFDG[MENT OF CONDITIONS
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<br /> • �.� The undersigned owneVapPlic�nt hcreby a9rees Io hold and rave harm-
<br /> — -- — --— �rss ihe Gty ci [veiett (mm any antl 211 claims lor dama9es. costs,
<br /> expenses. or ca��ses of aclion Ihat may anse oecause of installaiicn
<br /> —� p�L V„ � --_-______ Z� �1�,�� � and maiNenance ol �he improvemenl c�o�her ri9ht-of-waY use here�o
<br /> J���� 1_t��-- applied �oi and Iuriher a9rees �o remov^ same upon notice Irom Ihe
<br /> Apn�oved lor GnnslrucGon ����e Ci�y �nd tU� ����� P��� hc p�aPerry damegeL �hereby.
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<br /> RNA NSf�CTION - - �`��F' - Da�e
<br /> Approve?as Conslructe0 �<Ifl'IWfO OI An�J��CB�I
<br /> WORK AUTHORIZED BY TF i PE 7Mff MUST BE STARTFD WITHIPI
<br /> �.���e�� PUBLICWORKSDEPARTMENT 180 DAYS O� DATE P[R�PI' IS ISSUED AND THEREAFTER IS TO
<br /> � 3200CedarSlreet BE DILIGEN�LY PUFSUED TJ COMPLETION. THIS PERMIT MAY B[
<br /> Everett.WA98201 GANC[LLEC 9'!THE CITY UP'ON ANY STOPP�GE OF WORK ON fHIS
<br /> Phone:259�BF310 � f I PRCJCCT OVEfi dL` DAYS OUFIATION
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