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f <br /> ��yy� APPIicalion For i <br /> P�9BLIC WORKS PERMIT Date �i�aiG� <br /> PUBLIC WORKS DEPARTMENT Public Works Permil# � I ✓ <br /> 3?00 Cedar Street <br /> Everett,WA 98207 259-8810 <br /> � ��STING �UN 1 6 1991 BuildingPeimitN_5�7 _ <br /> IYPE OR PRINT ONLY Public Works Fee$ �� <br /> AZURE CONSTRUCTION INC 13208 136TH NE KIRKLAND 98034 <br /> Owner Mailing Address City Zip Phone <br /> DALE LLOYD $21-475G <br /> Applicant Ma7ing Address Ciry Zip Phone <br /> Descrihe Proposed Work NEW P.QI[;; – � <br /> ,�_ii�.nn �.n'�t�- _':.'•[=�El.�: � . <br /> �0065'�9.'_•7 - <br /> �..� u ...:,il;. V� <br /> 10405 7TH AVE SE LOT 8 ?i.'G ��':..77 <br /> PROJECT ADDRESS(if known) � <br /> � 1 CI�?i "rJ�' l. <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the following if applicable: ;^�.4,_t_ y!c:3p � <br /> 'Property Lines •Outline and dirriensions of all existing and proposed stmctures on ihe lol •Existing and propb'sed'utilities",l�nn <br /> •Cenlerline of street 9ndicate North 'Show any proposed grading changes •Show measurements=i.��'J C� ":9i?,'!- � <br /> -mrr.�noc� <br /> DO NOT WRITE B[LGW THIS LINE �::,;_; r;r �� <br /> PERMIT CONDITIONS: �;;��:y : ,�,� . - � <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. ,-:.,;�,r- ; �;,-;, ��, O <br /> 2. All work shall be pertormed in accordance with this permit and current City of Eyerett Design;and <br /> Construction Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> V♦ <br /> 1. F:er�p crta ;trccls cic.m at .�l Umc�. � <br /> Cnrb �utt�r aud sid���alk iu thc plat,u� nc�c ;uid uudamaoad. �uy d,uuaga �h�rvto shall L•- r�plac.:�{ al ilr li <br /> discretion of the Fublic Works lnspcctor, <br /> ��. Any chang�. in Ihc drivewa}' cut iuust bc appruved by thc YW Inspector, widlh at prop linc limitcd to <br /> r����inE,�pron�ti�idtti. <br /> Adjust watcr boxes �o grade at end of eonshuclion. <br /> S. Driveways shali he complctafy cu.rcu betore d�ivine on thrm. <br /> RqoNop draiti,ir; shoU b�, discha«,ed to Ihe stoiui di;iina��e stnb provid��d at lhr linnl oflhc Inl. <br /> U�/ � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � � � The undersigned owner/applicant hereby agrees to hold and save harmless <br /> � ths City of Everett from any and all claims for damages,cosis,expenses,or <br /> A o o Conswction Date causes of action that may arise beca��se ot installation and maintenance of <br /> PP` the improvement or other rightrof-way use hereto applied for and fuAher agrees <br /> ta remove same upon notice from the City and to replace public property <br /> � (,� 6_S—S� damaged lherehy. <br /> FINAL INSPECTION Date <br /> Appmved as Consiructcd <br /> Z- (3- g`1 <br /> Signa re of Applicant � Date <br /> WORK AUTHORI'LED BY THIS PERMIT MUST BE STARTED bVITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DUR4TION. <br />