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Z <br /> R1 - I —Z8-4 Pbm Worxe mtle Z. <br /> 08t0 <br /> Application For eiea Deer e Pn/ <br /> PUBLIC WORKS PERMIT °°°,.,,,V- 9 <br /> TO POSTING Lete APPI Fee Pea <br /> l e ti 2n� <br /> U� O CI fh Y. <br /> Print or Type Only O 9 <br /> 7(r.ayf�i�fi,1 _ .� :/��'!� .Plticl_J ZC1 509) 5d�1—CJ�ir<� <br /> C H Owner a_ ,.'WjilOg dr,�,,., City zip Phone <br /> H Ila <br /> Owner c S ( fi <br /> f �+ 1 <br /> H <br /> O <br /> Apl'liean Mailing Address City zip Phone 111 <br /> O y O <br /> til H �L <br /> y H d/gw [� na /1�owCR. J5z hLg&1n.E+tt aL 4 <br /> C <br /> Describe Proposed Work <br /> O H <br /> Q. C g W <br /> Zy y3[�! Project Address(II known, 'Z' C, Oth P L..Se. <br /> Cr Hy Attach four(4)copies of pians for proposed work•Drew to scale and note the fon,.wmg as applicau,e:rA �■ <br /> O H • Property Lines • ;enterline of street <br /> 0 17 IA •Outline and dimensions of all existing and • Indicate North <br /> s C proposed structures on the lot • Show any proposed gradin T changes <br /> ZH M • Existing and proposed utilities • Show measurements wA <br /> H O rn DO NOT WRITE BELOW THIS LINE W <br /> rFez <br /> PERMIT CONS <br /> 1.All calls forr Inspection shell be made 24 him In advance•phone 259.8810. r.ft <br /> 2.All work Shall be performed in accordance with this permit and current City of Everett Design and Construction 04 <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 him before you dig.TOLL FREC NUMBER 1.800.424.5555. z <br /> Lr3 4. Install rock construcl.ijn entrance behind driveway as per city aa,d— 4 <br /> -dard 0208 and erosion control as directed by Public Works <br /> Inspector. <br /> 5. Keep city streets clean at all times <br /> mar. 6. Qtrb mutter and sidewalk in the plat are now and Undamaged, <br /> any damage thereto shall be replaced at the discretion of the <br /> Public Works Inspector. <br /> 7. Any change in the driveway out must be approved by the Public O <br /> -.4 r1ft, Works Inspect,lr. <br /> 8. Tightline all roof, yard and driveway drains to storm drain <br /> stubs at back side of sidewalk. <br /> Vale, 9. Adjust water boxes to grade at end of construction. <br /> 10. Driveways shall be completely cured before driving on them. <br /> IMS0 ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> 1 less the City of Everett from any and all claims for damages, Costs. <br /> `^ expenses. or causes of action that may arise because of Insiallatiun <br /> and maintenance of the Improvement or other fight•ol•way use hereto <br /> applied for and further agre is to remove same upon notice from the <br /> Approved for CovAuction / Date City and to replace public prc party damaged thereby. <br /> FINAL INSPECTION Date L <br /> Approved as Constructed Signature of Applicant Dale <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Ceder Street 180 DAYS T DATE PERMIT IS ISSUED AND TIS PEFIFTER IS TO <br /> Everett WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS WORKMIT MAY IS <br /> Phone:2699810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />