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5 10 93 /' q �f�(p <br /> �B�B / / v — �—�^S Pub�ic Works Perm11• t '� `-� � <br /> Application For emo.oeo�.. <br /> PUBLIC ��ORKS PERMIT '°°:o,�FeeFee s <br /> T� pc►tTING� l'-�iT LeacnpPlFeePUCS <br /> . exlence Due S �� <br /> Print or Type Only <br /> C W Bright POB 1356 Snohomish WA ta8291 R% 485-1319 <br /> � � Owner MaiBng Address , City' . Zip Phcne - � <br /> Owner . . <br /> � . Applicant Idailing Address City Zip Phone <br /> Describe Proposed Work New house — basic 216 <br /> la�o8 - ZC� A+� sE W <br /> Prolect Address�if known) _ � � <br /> � � Atta:h(our(4� copies of plans for proposed wod�- Draw to scale and note the following as applicable: � <br /> � � Property Lines • Centerlir�e of street � <br /> � � • Outline and dimension .ot all existing and • Indicate North <br /> �� proposed structures or,the lot � Show any proposed grading changes <br /> . • Existing and proposed utilities • Show measurements � <br /> . ,� DO NOT WRITE BELOW THIS UNE O <br /> ; PERMIT CONDITIONS <br /> . 1.All calls for Inapectbn shall be m �+e 24 hrs.in advance•phone 259-8810. � <br /> 2.All work ahall be per(ormed in aa.,.rdance with thie permit and current City of Everett Dcaibn and Construction <br /> Stendards and Speclficetiona <br /> '� 3.Call Location Underground Service 48 hre.before you dig.TOLL FREE NUMBER 1-500-424-5555. � <br /> 4 standardrf1208c dter sion cont o`eae directed by PubliceWorks <br /> Inapector. O <br /> 5. Keep city etreets clean at all times � <br /> 6. �b gutter an3 sideWalk in the plat are neW and undsmaBed, <br /> any damage thereto shall be replaced at the diacretion of the � <br /> Public Worke Inspector. <br /> 7. Any change in the dcivewaY cut 'must be approved by the P�'� In' O <br /> apector, width at prop line liaited to existing apren width_ <br /> 8. Connect all ra�f, Yard and driveue4v draine to �torm �ain � <br /> oyateo�. provided to lot. <br /> 9. Ad,iust water boxes to grade at end of conetruction. <br /> 10. DrivewaYa shall be comPletely cured before driving on them. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � ����7, � The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the C�ty of Everett from any and all claims tor damages, cosis, <br /> ` nI, ' /,, /' ezpenses, or causes of action that may arise because of installation <br /> I////��/v/CUnc . /.� 7�5 and maintenance of Ihe im w ement or olher right-of•way use hereto <br /> 1�(� � �`�— �y applied for and fur o rem same upon notice from the <br /> App�ed r Consiruction Date City and to repla public op damaged thereby. <br /> � ,� � /1/if97 <br /> FI ALINSPECTION� Date <br /> Approved as Constructed Signature lic t Date <br /> - �A�� PUBUC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evere!t,WA98201 BE DIIIGENTLY PURSUED TO COMPLETIO�'.THIS PERMIT MAY BE <br /> Phone:259•8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />