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� .�v.,��,.�. �.,�.� <br />Date ��� G�1. CJC'� I� p T �� 2'�%i%- �� <br />� Q� I� __L-----'^°"" <br />ApUlication For ' �� ' <br />FUBLIC WORKS R'ERMIT <br />Print or Type Only <br />; �, <br />Publ¢Wo�hsPorm�t-+ � �`� � <br />c ; ��_ <br />Blap Dco�� • <br />Pubhc�vo�ksGce g <br />TolTl Fee <br />Less AO�I Fee Pai� 5 <br />�.� <br />eaia�ce oue 5 -' '�f'"' ----. <br />�� 6� — — — <br />_. . .. ___ Citv ZiP Phone <br />Describe Proposed Work <br />5U"� <br />Project F.r.dress lif knownl <br />�-,-a.t a�r�. iJ EsT <br />h I I'cwing as applicable: <br />AttacL icur (4) copies ol plans for proposed work - Uraw to scale ar :_ nole t e o, <br />• Property Lines <br />• Outline and dirnensions ol all existing and <br />proposed struclures on the lot <br />• Existing and proposed ulilities <br />• Cenlerline of sireet <br />• Indicate Norlh <br />• Show any proposed grading changes <br />• SL-ow measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be matle 24 Ivs. in advance- phone 259•8810. <br />2. All work shall be performed in accordance wi'.h ihis permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800•424-5 • <br />ANY CHANGE IN THE DRIVEWAY CUT MQ5T EE APPROVED <br />BY THE PUBLIC WORRS INSPECTOR. <br />CON:7CCT DOWNSPOUTS TG PUBLIC DRATNAGE SYSTEM. <br />K3EP CITY STRSSTS CLFAN AT ALL TIMES. <br />TOYTHEMSATT.SFACTIONUOF THE PUBLICLWORKSLDEPTREPAIREi� <br />Z �� <br />Dale <br />�r, // -1�'� <br />FINAL INSPECTION <br />Approved as Construcled <br />everetl PUBLIC WORKS DEPAR'(MENT <br />� 3200 Cedar Sireet <br />Everefl. WA 90201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby a9rees to hold and save harm� <br />less Ihc City of Everett Irom any and all claims fo� damapes, cu:ts. <br />exFenses, or c�uses of aclion ihat may arise Grcause ol ins�allation <br />and mainlenar.ce ot ihe improvement or other righFof�way use hereto <br />applied for ard furiher agrees to remove same upon notice from the <br />City and to replace public property dam29ed lhereby. <br />��..� �°,�t-� �3-/�-90 <br />�� Date <br />Signawre of Apph�aN <br />'NURK AUTHORIZED BY THIS PEfiM1T MJST BF STARTED WITHIN <br />180 DAYS JF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLC-D BY THE CITY UPON ANY STOPPAuE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />