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✓' <br /> �, ,� i�� <br /> � I P�ipqc Wo�ks PCnril a <br /> I�• <br /> � H D2�eJ�— � oiee o�oi . � ' ���-�- <br /> � qpplication For <br /> PUEILIC WORKS r�RMIT Pu�LCWarN9PCC <br /> 10 l�9 ioim Fee S <br /> �' ~ "'__ <br /> y tes��no�.rn. Pam 5 <br /> p.� Baiancno�e S C='l'� <br /> K � Print or Type Only <br /> ro � �°a . <br /> N N 1 I �/ 7 1 ! � ` ( <br /> . � <br /> � xo � � I� �� � � I d � � /- � . 1 � I • �'� . - � � i II I 1J I �` �I � r :� le_ � �; �� '".�I� '��. <br /> i <br /> �7 Oe+ner � Mailing Address C�ry Zip Phone I <br /> '��0 � O � <br /> M . ll U — <br /> Zy y Applitant Mailing Address City Zip Phone . <br /> r � <br /> H , . � <br /> pp % � � ����.�C <br /> Describe ProPosed Work � � � � ' �— �<- � ���� � � ' �F� 1 �� t I � '� i � �` � �- � I <br /> A � � • <br /> C N 7 l i <br /> � C � •l �� � ..,�� _— 1 <br /> W I <br /> O N , <br /> 1 <br /> Proiect Address(if known� __ <br /> 1_C�-1. � - �k9Tlt i��� c�'. st.l __ � � <br /> � � <br /> Attach lour(4)copies ot plan; ior propwed worl:� Draw to scalc and note ihe followin9 as apUlicable: � <br /> • Property Lmes • Centerline of sireet <br /> • Outline and dimensions ot all axlsting antl O Indicate NorUi <br /> proposed struclures on the lot • Show any proposed grading ch���nges <br /> • Existing and proposed utililies • Show measurements M <br /> W <br /> ��� DO NC'T WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS o <br /> i�� �--�-\ 1.All calls for inspection shall be made 24 hrs.in advance�phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with ihis permit and current City of Euerett Design and Construclion <br /> C� Standards and Specifications. <br /> , 3.Call Localion Underground Service 48 hrs.k=fore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> 1 4.ANY CFiANGE IN THF, DRIVEWAY COT MQST BE APPROVED <br /> �� BY THE PUBLIC WORRS INSPECTOF. <br /> �+� 5.�ONNECT DOWNSFOUTS TO PUBLIC DRAINAGG SYSTEM. � <br /> � 6 .Y,FEP CITY STREETS CLEAN AT ALL TIMfiS. � <br /> 7 .ANY PAMAGS TO THS CURB AND SIDEWALR WILL BE REPAIF.ED <br /> TO 'fHE SATISEACTION OE THE PUBLIC WORRS DEPT. //� f <br /> I �� V♦ <br /> � O <br /> ��_� a <br /> � ,�� 1� AGKNO\7LEDGEMENT OF CONDITIONS � <br /> !�" �a\�' The undersiyned owner/applicaN hereby agrees to hold and save harm- <br /> 'i less the City o! Everetl hom any and all claims for damac�es, costs, <br /> e�penses, or r,auses oi action that may arise because ot installation <br /> � � /� C L I �l �ud mainlenance ol the improvement or olher ri9ht�obway use hereto <br /> � ���8—�/`�'�'�`�/'�� applied for and lurther 29rees to remove same upon notice irom the <br /> ' �� Approved for Construction ��� ��e City and to replace puulic properiy dama9ed thereby. <br /> �1= � J � �,` I <br /> �.`' —," ' `i- _ v. � <br /> FINAL INSPFCTION �— ���e �t�—�— 3 y `� . <br /> Appwved as Constructed Siynature ol Appl cant Date <br /> WORK AUTHORIZED BV THIS PERMIT MUST BE STARTFD WITHIN <br /> everett PUBL'CWORKSDEPARTMEN7 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAF?ER IS TO <br /> � 3200 Cedar Streel OE DILIGEN7LY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCFLLED BY THE qTY UPON ANY STOPP4GE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DUFATION. <br /> I <br /> 1 <br /> � <br /> f <br />