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Date <br />10�2�9$ Application For <br />PUBLIC WORK <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />T��� ��sriN� <br />� <br />S ��RMIT <br />Q <br />O <br />7 <br />n <br />,��Jt�_ �� ( 1'���' <br />O G O O a n <br />�' d O O 1 n O o� <br />o ��o�o� <br />��i -o m.0 w ra r.� <br />�ww .a� <br />o � <br />ariny names� [� � �'� <br />� OG�1alL=.lU�l�-�i <br />O �filC �u'O <br />Pd;,dn�,:7 Address <br />NEIJ HOUSE — BASIC 1121 <br />Project Address lif knownl ' ��J� —����1 r I�G� .'" <br />Crty <br />AttaCh four (4) Copies ol plans �o� nropused wurk � Drav: to sralc antl nclr the lollc�vmg �s apUi��.:�h�e <br />• Property Lines <br />• Outline and dimensions of ali existina and <br />proposed sirudures on Ihe lot <br />O Existing and proposed utilities <br />/ <br />PubLc. Y/orAs Parmd . �5,, V ."..: _— _ <br />oai� o�o� • 496 7 4---- <br />FubLcworws:ce S <br />iot, I Fce <br />Less Aon� Frte Paa $ <br />�aiance �uc S � <br />• Cr.ntedine ol streel <br />• In,dicaic� North <br />• Show any r,ronosed yraCino r.hanues <br />• Show mea;urements <br />Phonc <br />Phon� <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•88i 0. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />l. krep crtV sheets clean at ail limes. <br />:. Cwb gutter �ud sidz�vallc in thz pist �rz �iew m�d undwna!�ed, mry damage thzrcto �half ba rzplaced at tl�c <br />�iscrctio�� oPdre Public Works G�spectm. <br />6. Atry chan�z in th� diiveway cut must be approv�d by the Fublic �i%orks IIupecror, widUi at prop Gne 6nuted n <br />cxismig aprou width. Ddveway may Iaper graduall}� to mect o�a<_;e door enhanec (Por an app�rovod ; car <br />�,an�gcl. <br />"'. Adjust waler buxes to grade at end of coiistructiou. <br />S. lli��sion 2 Lot� lots 3;1,5 cC H Sti9�I f�lSftlfil�;8 1'OORO� (II"tlll;l'_': �0 ILc lot= infiltrafion uzncti as p^r ilie <br />"f �ispersion 'freoeii 17etail" on sheat 5 of tlie plats consuuclions pl;ms. A prrconsuuction mcetu��; nmst be <br />�cLed�dad witli rUau I.ocl:e (3SS-9u55 mcb. or 259-5�10 oftice) p�ior to url�Il�hUll Oi ii1C IIIFIIIf8110i1 ,�: t,n�. <br />Lry chmige ut thc infil:ralion hencL nutst be approved bV ��. F'��blic �Vnrks L��pcctor. r1ll etlier let, in <br />liivision 2 sLall disd��ee rooftop draa�n�e [u tlte stonn draiu stuU ��rovided to the lut. <br />,/,� ACKNOWLEDGE�1ENT OF CONDITIONS <br />bf—�%o ro/`t> --- <br />i <br />1����,�- r%r/�r- ; <br />ApproveA Construction _ �� i <br />� �5 7 II <br />AL PECTI N Date � <br />Approved as Constructed j <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />�T% Everett, WA 98201 <br />Phone:259�8810 <br />W <br />� <br />_ / <br />�� <br />� <br />■� <br />� <br />♦�^ <br />V♦ <br />� <br />a <br />The �.indersiqned owner/apphcant hcrp,by ag�ees Io hold and sav� hann� <br />Idss th¢ City ot EvereU Irom any and all claims for damages. cosis <br />eapenses. or causes of action that may arise because of installation <br />and maintenanr.e n! tha improvement or other nyh4of-way usF h��reto <br />apphed for and further agrees to remove samn upon nolice trom liie <br />C!y ind tn replaca nublic property damaged thereby- <br />� �� __ <br />Signawre f AUPhcan! �— �e�� <br />�,NOP,K A TIiORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />tA0 DAYS OF DATE PERMITIS ISSU[D AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT �J�AY BE <br />CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.�EGT OVER 90 DAYS DURATION. <br />