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I <br /> Mill .1 <br /> J <br /> Date.2 ra ur.w°n.namn• -Ob/S79 <br /> H 0 i^ Application Foi AIN Dear .'�3 f 7 ] _.__.. <br /> s PUBLIC WORKS PERMIT Nt,"'Cl.-F.. -- <br /> S <br /> Q H i•u aA°i rn.rn.a 5 <br /> 9 H N <br /> D, <br /> $ <br /> 2� <br /> y3 Print or Type Only —' <br /> H0 <br /> HItTCclN g8o/z yI'/-FELL <br /> r) JE'�s <br /> y ,Owner Mailing Address Cdr Zip Phone <br /> x 3 <br /> 00� - 41)..... <br /> z m C7 .oplicant Mailing Address City 7m PhonEtj <br /> , <br /> �� C1 <br /> x' H Describe Proposed Work - <br /> t. H <br /> r x <br /> H H <br /> y <br /> H _ <br /> C"7 C7 r/I 1 1 <br /> RC37 i�r 1 OL -�C>, y,cr PL. 5E `jJ <br /> Z H rA Prolect Address(If known) ,a: <br /> HON <br /> Attach lour(4)copies of plans for proposed work-Draw to scale and note the tollowinl OS applicable xis <br /> • Property Lines • Centerline of street <br /> •Outline and dimensions of all existing and • Indicate North v+ <br /> proposed at uctures on the lot • Show any proposed Grading cl anges <br /> _ • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WniTE BELOW THIS LINE 6 <br /> PERMIT CONDITIONS (�/' <br /> w t t.All calls for Inspection shag be made 24 his.in Advance-Phone 259.8810 Paso <br /> 2.All wurk shalt be performed in accordance with Oil;permit and current CJy o1 Everett Design an'.Conslruction d <br /> Standards and Specifications. <br /> '�.►' 3.Cell Location Underground Service 4B his het ore you d,g TOLL rnEE fI UM BER 1.800.424.5555 <br /> w wn 17/x' <br /> 4 .ANY CHANGE IN THE DRIVEWAY CUT MUST BE APPROVED 0 <br /> �.� BY THE PUBLIC WORKS INSPECTOR. <br /> 5.CONNECT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. <br /> B.KEEP CITY STREETS CLEAN AT ALL TIMES. <br /> 7.ANY DAMAGE TO THE CURB AND SIDEWALK WILL BE REPAIREDCn <br /> wl.. TO THE SATISFACTION OF THE PUBLIC WORKS DEPT. O <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ' Y _ Theundetcignedowner/applicanthcrebyailreestoholdandsaveharm- <br /> loan the City of Everett from any and eG claims for damal-s costs, <br /> expenses, or causes of action that may arise because of installation <br /> RX�Q A4��ta... -1_9p and maintenance rt the improvement or v other right n nota use hereto <br /> end ma for and l of the <br /> agrees ro to remove same upon way u from the <br /> Approved fa Coi.str n Date City and to replace rubles property damaged thereby. <br /> s <br /> FINAL INSFS TI N Dale <br /> Approved ao Constructed Sig lure of A IZED WITHIN <br /> everetl PUBLICWORKS DEPARTMENT WORK AUTHORIZED PE THIS PERMIT MUST BE STARTED WITHIN <br /> © TO <br /> 3200 Cedar Street 180 DAYS T OATF PERMIT IS ISSUED AND THEREAFTER IS BE <br /> Everett WA 98201 BE CEL DILIGENTLY BY PURSUED 70 COMPLETION.THIS PERMIT MAY IS <br /> Phone:2598810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />