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bate___-_ p -- <br /> Puelm wdlle P.rm,l a JCl/SI,/ <br /> l•PPI¢allon ror <br /> Bldg <br /> PUBLIC WORKS PERMIT '"KWPl . il, rye <br /> 4.Al1Y Pumm wort re. �— <br /> CNANOR IN TUR (] rolelFe, <br /> Print or Type Only TO POSTJNG_ iia Q� LeaeAdel Fos,Pa,d $ <br /> osteons ere =�Q pfd <br /> �_I yr sE �►.�cr -S - �� <br /> Owner Mailing Address - - <br /> City IIP <br /> / ( Phone <br /> Applicant <br /> Describe Proposed Work Melling Address <br /> City Zip <br /> r Phone <br /> Pro)ect Address lit known) c)9 — Ca,L ST- <br /> Attachfour(4)copies of plans for proposed work•Draw to Scale and note the following as applicable: <br /> • Property Lines <br /> • Outline and dimensions of all existing and • Centerline of street <br /> Proposed structures on the lot • Indicate North I w <br /> • Existing and proposed utilities • Show any proposed grading changes <br /> V/1 I <br /> • Show measurements q� <br /> 00 NOT WRITE BELOW THIS LINE W <br /> PERMIT CONDITIONS <br /> 1.All calls for Inspection shall be made 24 fire.in advance-phone 259.881 1), O <br /> 2.All work shall be performed In accordance with t•Is permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.beforeou+1 <br /> Y a TOLL FREE NUMBER 1.800.424.5555. l <br /> Z <br /> 01/02/91 11:03AM 0004"5114 1O <br /> i <br /> "00025921 <br /> BLDG $545.00 <br /> 4.ANY CHANGE IN THEDRIVEWAY CUT MUST Bfi APPROVED �� 55.00 <br /> BY THE PUBLIC WORKS INSPECTOR. t1FCH $110.00 114.50 O <br /> 5.CONNRCT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. WVWYM $20.00 ^ <br /> B. KEEP CITY STREETS CLEAN AT ALL TIMES. an <br /> 7.ANY DAMAGE TO THE CURB AND SIDEWALK WILL HE REPAIRED"7085 <br /> TO THE SATISFACTION OF THE PUBLIC WORKS DEPT WATER $105.00 <br /> ACKNOWLED F�goIipNS <br /> The undersigned Owner/app114jf1t11aRaJeh <br /> less the Clly of Everett fro Y1lWftW hold and save harm- <br /> expenses, or causes of action and�l«71r:!�{ for damages, costs <br /> a may then because of installation <br /> ----1 l� and maintenance of the Improvement or other right-of-way use hereto <br /> rise <br /> APProved for Consiruclion applied for <br /> /J Date City end e d f her agr s to remove same upon notice "0. the <br /> ��_ !/ _ P e p 1 perty damaged Thereby. <br /> FINAL INSPECTION TT r <br /> Approved as Constructed Date <br /> IVT Wit Dale <br /> PUBLIC WORKS DEPARTMENT Sign ure 0 Ap Team <br /> WORK AUTHORIZED BY THIS PERMIT MUST DE STARTED WITHIN <br /> Ever tt,WA Street201180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 Phone:259.8810 BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br /> CANCELLED e'r THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> ------- _ PROJECT OVER 90 DAYS DURATION. <br />