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� � <br />� <br />, <br /> Date—U,7;�Gj� ,,,.: . .. ,.;�".,m,�. _ � � . - �� � __ <br /> APPIiCa�ion For n, eia� Depe+�f�r, n ,7(��_ <br /> yx"� PUBLIC WOR�KS I'���Rl�j��- � — � " _ P�„�,�v,o,k=F�� -- <br /> LTl 9 y rotai Fa� 5 — <br /> .�'�1]H LeSSAnP� Fe��P:nU 5 <br /> 4• '- - ��LZ� <br /> 9 H C/� '�si ,_�'^, �i �"ri �o o ci r��:i�3x:,�,�.o�.o S_-�` <br /> C x Print er Type Only „ . . . . . . . — <br /> FI a� ra P In �� <� „ r� ci c,'� <br /> y Z H r � .r rr :, r�.i �n „ �„��:�- <br /> � a/i bl N ht <br /> � �� �.� t> � .:.�_��. <br /> Q r ti r <br /> � H� � t'U/� �/�(�J �_Li � (�� ?c.� ��l \ �� `��f l��—�-��'yrJ� — <br /> y H O�vner 'Maiiin9 AAdress � C�� C��fj[i - p :� �•.i ¢ `Li{�.: phone <br /> t�� O U' C:i '= ' 3 O W � �.� ��� <br /> y y� r.i oomu :n � a �- o 3 :�._i.::. <br /> \ O J J W C< O �2 O W �-� �'- <br /> � om SGM � ; vw � Y_ � � �: 3 � �� _.,�- <br /> Hb - <br /> O H Applicant Maihnq Atldress City Zip phone <br /> � �� Descrit:e ProPo��ed Work ���1��(���_�����/'� LO ��� r�,flr ,,�� . � �� <br /> Cy� — - - — <br /> HH <br /> b � <br /> O �N 1 � , <br /> � �[rz) Project Address lif known) � �9UZ ' �._�jTit �'iZ SC, � <br /> x y�n —-- ------- <br /> H O� Attach lour 14� cOpies of ptans lor p�opo;�'d wnrL.- f]i,nv lu sraL• ;ui� npte m.� I;,Il�vimy as aophcaol� <br /> � <br /> • Property I ;nes • G���teiline ol =_Irei��t �^ <br /> • OuUine and dimensions o�all ezisbn�; dnq C In�f�rate Norih V� <br /> propo5etl StrUGtures on�he �o� • Shoe. any proppti„rf qrad�n;� Uian�es <br /> • Exis'ing and propo5ed ulihhe5 • Sno�.s mu:isu�emm�ts � <br /> DO NOT WRI7E B�LOI"J?HIS UPJ[ � <br /> `v„ PERMIT CONDITIUIdS <br /> �� 1.All ealls for inspectron shall be made 2A hrs.in advance�n��one 259-8810. � <br /> 2.All,vork shall be performed m accordance with Ihis permit antl current City oi Everett Oe;�gn and Conslruction <br /> Standards and Specilications. <br /> v � 3.Call Loca�ion Undergwund Service 4B hrs.belore you d�g.TOLL FREE NUMBER 1-$00•424•5555. � <br /> � � q. TnRtai.l r�ck co:ntruct:ion ent:rance hehind dc•iveway a� <br /> F�r citY i�l:andard tt20A +:o eLiminzCe Y.rar.kinE; mud onto O <br /> r,trerCr� as d.ir•erL�a hy Piibl ic Worka In�pector_ <br /> [i_ Keep cit:Y At.reeCR cl�an at ail time�_ <br /> `� 6. Curh, E,vt:ter ard nidewai_`r in t:h� �Iat nre new and L <br /> un?.+marP�1, .�ny dam�p,e thet�etn ahall t�r rAp)aced at. Y.he r <br /> e.�. disr.retion of Lhe Public 4�orkrs T�c�pector_ ♦/�1 <br /> �� 7_ Any change in the drivewly ^.ixY, muAY, be approved by the ��� <br /> Yubl ic Woc•ka innper.t:nr_ O <br /> 8_ Tightline all roof, yard and driveway drain� from <br /> ;"" "°' houfle� to publ ic drain.i��e tiyatem. ^ <br /> ! 5. Ad,i��Rt WI�:P.'P hOXC9 to grade at end of construcL'ion. �� <br /> 70. Urivewayfl s6a11 be completely cured 6ai`ore dri.ving on <br /> t:hem_ <br /> ""� i �y�.1� ACKNOWLEDGEMENT OF COMDITIONS <br /> - ��(l.�j The undeisiynetl owner/applicant hureby agrees�o ho��d and seve harnr <br /> l �/� --- — - less the City ol [veret� Irom am• and all claims for Aama9es, cosic. <br /> i+apenses. or causes of achon ihal may arise Uecause of installation <br /> �(�n LY{ L'� � and maintenance of ihe improven:ent or o�her ri9h4of-way use hereto <br /> ��• � � �-���� applieU for anA iwtp�� a9rees to re�ue�ve same upon notice Irom �he <br /> ApProved r Con truction Date Cny nntl b�ep�e6 public pro �ty damagetl therehy. <br /> �i / � <br /> <� / i i' <br /> �� � l � �-L � � <br /> L �� /i"� ���i�s,�/ . __ X^ �/ � <br /> FIN\L MSPECTION `'' . . � � � U:lle ����//�l�' " "'��r��—�--�_ <br /> APF•oved as Ccnstructed qn dme ol Applicam ' Dale <br /> e crelt PUBLICWORKSDEPARTIdENT LNORY, AUTHOR¢ED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireet 1N0 DAYS OF [�ATE P[RMIT IS ISSUED AND THEREAFTER IS �O <br /> EvereV,Wn98201 '�E DILIGENTLY PURSU[D TO COMPL[TION. 7HIS PERIdiT M.4Y BE <br /> �� Phona 259�0610 '•NCLLLED BY THE CITV UPON ANY STOPPAUE OF WORK ON THIS � <br /> _ I PROJ[Ci OVER 90 DAYS DUfll.LION. <br /> �; <br /> � <br />