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� <br />� <br />TYPE OR PRINT ONLY <br />ApPlicalion For <br />PUBLIC WaRKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 259-8610 <br />?�r+ PO�iING �uN 1 s iss� <br />Date_ 1-22-97 <br />Public Wc:l;c permit N _�039 <br />euildin9 Permit N 5_ Gp33 _ <br />Public Woiks Fee $ _2 Q � <br />_ Kay/.7ames Matteson 1541�; 29th Ave SE Mill Creek 1dA 98012 <br />Owner �� _ <br />Mailing qddress <br />City Zip <br />City Zip <br />Describe Proposed Work <br />PROJECTADDRESS (if known) �Cl7- <br />A!tach four (4) copie�. of plans for proposed work - Draw to scale and note the following if applicable <br />"P�oP2hy Lines •Outline and dimensions of all existing and pro o d <br />Lot 5 SP <br />316-8361 <br />'Centerline of strzet P se structures on ihe lot •Existing and proposed utilities <br />� •Indicate North •Show any proposed grading changes •Show measurements <br />��.. i�vi vvrn � t tltLOW THIS LINE <br />PERMITCONDITIONS: 0^/!.9i97 ";^7.>;a ;�;r-�,,r� <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-Sg1 p, ;���ns�.��,- <br />2. All work shall be pertormad in accordance with this permit and current City of Ewecgtt Design and� <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before "' "u =?7,-;., <br />you dig. TOLL FREE NUMBER,;1-800-424;SSb5. <br />SS'���t3 --'__ <br />i. t;kPJi�'�' :^; ,., <br />KCC�� city s(reets cicau at �dl tiuics. ---�- <br />5 �G�1�05^?7 _ ' - ,.. <br />Ctub gutter mid sidew;ilk ui the �ilal are necv and nndamaged. ;iny dama e Ii, <br />G�' `� ' 05.._, � <br />discretion of U�e Public Works Inspector. K:��J��r����� ��I�t���'�� ,il <br />`� A�ic clians�e u� the dtiveway cut rnu,t he approved by the P\y' L�s cclor, <br />:6:5� �?Q.pO <br />exisling apron wid(1�. P �!; ro f lireitcd to <br />, .,��•��� �'.t�o�� <br />Adjust water boxes (o grarte at end ot�eonshuction. �`��IiT =�=�0.0� <br />:s. Diiveways shall be completely cun.d bcforc dricim� on Ih.:nt CHEC'; xi�6g�.80 <br />`� Iiooitr�p dr;iiizaRr =h�ll br discharged fe the :tomi drain;i�-r �hfi loc;�t,�l ;tt Nie Front of Ih: In( <br />� HCKPJOWIEDGEMENT OP CONDITIONS <br />w/ �i � � The undersigned owner/applicant hereby agrees to hold and save ha�mless <br />�_� � Ihe City of Everett from any and all claims for damages, costs, expenses, or <br />Approved for Construction —' py�e causes of action that may arise because of installation and maintenance of <br />� �A ihe impmvement or other right-of-way use hereto applied for and further agrees <br />�!�,/!/ d� to remove same upon notice from the City and to replace public property <br />�� X"" (ji — �,2 — -�j 7 damagetl iher �(iy, <br />FINAL ��SPECTION � Datc —�F <br />Apprcvzd as Consimcted <br />— Sig at o L ����r —A� �� U— �7 <br />WOFK AJTHORIZED BY THIS PERMI7 MUST BE S7ARTED lh'ITHIN 180 DAVS OF DATE PERM IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCE�LED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />/ <br />