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--- --- --- --- ---.-- <br />..,�- - - - <br />. �I, `,', <br />Date �'6-53 <br />.� <br />PUBLIC <br />Print or Type Only <br />Naneon Nomee 237 <br />Applfcetion For <br />1MORK�S <br />_ _ �_� . ."""�,,"�'— : ::�'�ti,i�i�+w�+i+vM►:.��+N-.«�^%+�+� <br />� G <br />L - u� -�8- � � ; <br />Pvelie Won� Permll � ��_ � <br />.i�1(TN `I 6iane ' <br />" 1-• r I I1�� •r B�ae Daot •_ I <br />P� �� � vumrt worw. r.e , <br />Tol�l Fss � <br />Sf7 OC L�.O S <br />���«�� � <br />N <br />Adtlresa � � � � � r�i� � j� � tj � �� � <br />rn Q <br />� <br />+I Fp Putl i <br />�ue 6 � <br />Oaner <br />A pllcent Malling Addreas Ci�y Zlp Phone <br />Daecribe Proposad Work new houee <br />Pro�dct Addreae lil known) <br />Attech lour (4) coples ol plens lor proposeJ work � Orew lo scale end note the lollowing as epplicable. <br />� Properry Ltnes � Centerline ol elreel <br />• Outline and dimenelone ol all erielinp and � Indicele North <br />proposed structuree on the lot • Show eny propos6d graAing chenpee <br />• Existinp end proposed utllit�ee • Show measuremerle <br />PERMITCONDITIONS " <br />1. A�I CBlis f0� InepeCtlOn ehBll be mBdB 24 hro. In edvence • phOne iS9'eei�. <br />2 All work ehell be peAo�med In accordence wlth ihle permlt end curreM Clty ol Everett Dealpn entl Ccnefructlon <br />3tenderdeend3pecllicellonn. ' <br />3. Call L etlon Underpround 3ervice 40 hro. belo�e you dip. TOLL FREE NUMBER 1•800�424•5Sb5. <br />4. �net.ell ror_k coriAt:rur_r,ion entrence behind drivewr�y ae pAr r`ity <br />etandard 112nB and nr�niori c:onhrol ns r3ir�ct�d by Fublic W�r'ke <br />Inepec`or. <br />". Keep cJty atreeta r.lean at all timea ', <br />8. Curb gutY.er and sldewelk in the plat ere new end undemagi�d, <br />7 <br />A, <br />9 <br />10 <br />� <br />�1 <br />Approv �f Con: <br />, <br />eny �1nmr�ge thareto nha11 hp rep]nr.,ed at, t.he di�r.retion ot the <br />Fuhii�• Worke Inepenctor. <br />Anc chnnge 1n the drlvPweY rur, nuAt be approved bY the PW In <br />spector, wldth at prop ]ine llmited to exir+tinq apr��n width. <br />Connect el] ronf, vard an�i drivew�y dr•elne to etorm drain <br />eyetem provided t�, ]nt. <br />Adiuet v�eter hoxes t.n gradP nt end of conetructlon. <br />DrivewAyA nhall bF rn�y,]At,Plv �ured lieforA driving on them. <br />Approved o� ConaVucled <br />�PUBLIC WORK3 DEPARTMENT <br />3200 Cetler Slreet <br />Everett, WA 68201 <br />PNone'.259•8810 <br />ACKNOWLEDGEMENT OF CONDIi1�N5 <br />� <br />O <br />� <br />� <br />O <br />a <br />Thr undersiyned owne�/epplicenl hereby egrees lo hold entl seve harm� <br />— lesa the Gly ol Everetl trom any end all cleima lor demegea, costs. <br />� eMpenses. m causas ol ection thel mey arise because ol Installation <br />�.� end meintenance ol the improvernenl or olher right-ol�way use hereto <br />=� ef�P�ied lor and lurther a��ees io iemove seme upon notico Imm the <br />Citv and to replace pubhc property da ad thereby. <br />- ��,�,1� --� >�- 9�3 <br />3ignalwe ol Apphcent Dale <br />WURK AUTHORIZEO BV THIS PE�iM1T MUST BE StPHTED WITHIN <br />1B0 DAVS OF DATE PERMIT IS ISSUED AhU THFREnFTER IS TO <br />BE DIL.IGENTLV PURSUE� TO i.OI.1M'LETION THIS PERMIi MAV BE <br />CANCELLED BY THE CIT'/ UPON AI:Y STOPPAl3E OF WORK ON THIS <br />� PfiOJECT OVER 90 D\VS GURATIOq. <br />