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Date 12/5/94 <br />Application For <br />PUBLIC WORKS <br />Print or Type Only <br />qpplicant <br />Describe Proposed Work <br />Prolect Address (if known) <br />�Q i �aS-e9`s�lG <br />n,. <br />PE R��1A I T <br />c[ <br />C] <br />CJ <br />_i <br />r"� O C O �. � O <br />c, r.a u r-:i i. �.� <br />�� i r,; �,i `-� :.` � i <br />.-} +�i �,. „� . <br />_i <br />fi_ <br />U' <br />ri <br />.�r <br />oit i'il� � iid <br />Mailing Address a <br />b <br />N <br />Nailing Address <br />� �� GitY i'i �' <br />c� co c� r_ ,� �� _' <br />O [;� w L1 .) C � �' <br />O J J I I I La: `. <br />3C iii u. i_ L i (�'� 1 <br />New house — Basic <br />Lot <br />q 3 ,'.,Z � <br />�u�l¢ WorAs Permlt s <br />e:eg.oea�., Gti4F,S � <br />i .� <br />VubLc WorkS Feo $ ' � <br />Totai Fee <br />Less AOA� Fee Paid $ <br />f._I I'' f ' �"1 _ <br />. r: c4�"�,r...: <br />p�. Pi CJ C> :1 C'� <br />V� �] v] _, a�� p.� <br />. .,. +�2 <br />u: <br />Zip �? �- <br />(^I !J'� 1- (J L _ <br />i <br />LI J.I lJ [ 1 f. i� <br />., _. I . ._.. <br />Zip <br />Attach lour (4) copies ol plans for proposed work - Draw to scale and note tne following as applica6le: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />h -P C] p •: <br />�l pJ .�] , <br />{1'� i. i ('� 111 <br />Phone c:� �.� <br />n <br />C7 CJ _T.. �'J �' _ <br />.. : ( J !�l !. I � . i <br />J ��� LiJ 1 -: <br />.. _r_ .. i . r'� r.r <br />Phone <br />Sid Estates <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />Y� PERMITCONDITIONS <br />" i. All calls for inspection shall be made 24 hrs. in advance- phone 259-8810. <br />Y 2. All work shall be performed in accordance with this 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•424-5555. <br />L F:ecp city sheets clean �t all time�. <br />5. i:urb �urter and sidewalk in �he plai are new and und:un�iged, �ury darnaQe theretc sliail be replaced ai ILe <br />discrctiou of th� PubGc Worl;s 1��spzctor. <br />6. Am� chanee in Ihe drivew.n� cut must be appiaved by Oie Public Works [nspecto�. evidth a1 prop line <br />limiic�l lu e�i�tin�. aprm� widlli. llii:cw;ry umy I:I�ICf �'191IU8IIY IG IIICCI em,lf!C iI001 CIIII.aia (Ib� au <br />approved 3 c�r �;uate). <br />�tdjust wnter hoxes to �ade at end ot coi�st�ictior. <br />3. Lols 5 Ihiu 12 �h:dl cliscLtuge roollop di�I11U�'C f0 UIC S1011ll (II.WI SIll� �I0�7fIC(I (0 III� IOI. <br />Q 1 o�s I ihm -1 �hall di�ctr�r�c rooRop drtinagc to thc lots inliltrahon trench �s per tlie "Dispersion T'rench <br />Detail" on sheei i o'r ilre plois cousituctions pla�ts. rl preconslniciion meetin� must be scheduled with AI <br />LucLe (3S3-9GS5 mob. or 259-3310 otTice) prior to u�st�lfation of tl�e uililtration ryst:m. ,1ny chan�e in <br />Ihe in�ilU',i�ion Irench ntust be apprnved by the Public Wmks (nspector. <br />App� onstruction ' ' Date <br />' �--�0 —�S � <br />FINAL NS CTION �� Date <br />qpproved as Conslructed <br />PUBLIC WORKS DEPARTMENT . <br />3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone:259-BB10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />V/ <br />� <br />a <br />The ::ndersigned owner/applicant hereby agrees to hold and save harm� <br />less the Gty of Everetl irom any and all claims lor damages, costs. <br />ezpenses, or causes of action that may arise because of insta!lation <br />and main�enance of �he improvement or other righf-of-way use here�o <br />applied for and lurther agrees lo remove same upon notice from the <br />City and to replace public properiy damaged thereby. <br />� J � L� <br />Signature ol plicant Date <br />WORK AUTHORIZED BY THIS PERMIl� MUST 8E STARTED WITfiIN <br />7B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />