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a <br /> xH n pete�L� `1/ welw won,rr•mi - 375'��q <br /> c PUBLIC WORKS PERMIT "TMaFe <br /> ayrn <br /> H 5ee <br /> �.nrfrr�Fa.r.�n s <br /> " TO POST 111 s �' 4L zc�- <br /> 0<y 0 Print or Type Only a..M.nv $ <br /> pC � <br /> F3 CO el <br /> 1.1 O Owner Mamng Address City Zip Phone <br /> OH �d�77 <br /> [till O <br /> 0 0 Applicant Melling Address Gly Zip Phone <br /> H <br /> 'y H Describe Proposed Work �--JI L40+ M; <br /> 1 H <br /> cl <br /> Project Address 111 known) �'.L.•3 — s 1ST PLr <br /> Attach lour(4)copies of r ins for proposed work-Draw to scale and note the I)flowing as applicable. a� <br /> • Property Lines • Centerline of street /A <br /> • Outline Ana oimensions of all existing and • Indicate North v+ <br /> prc,,osed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW <br /> PERMIT CONDITIONS THIS LINE A <br /> ' law } 1.All calls for Inspection shall be made 24 hrs.In advance-phone 259.8810. <br /> 2.All work shall be performed In accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> I 3.Call Location Underground Service 48 hire.before you dig.TOLL FREE NUMBER 1.800.424.5555. z <br /> 4.ANY CHANGE IN THE DRIVEWAY CUT MUST BE APPROVED O <br /> BY THE PUBLIC WORKS INSPECTOR. <br /> 5.CONNECT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. <br /> I ��1_� R.KEEP CITY STREETS CLEAN AT ALL TIMES. I <br /> 7.ANY DAMAGE TO THE CURB AND SIDEWALK WILL BE REPAIRED CIO <br /> TO THE SATISFACTION OF THE PUBLIC WORKS DEPT. O <br /> a <br /> !1 <br /> I ACKNOWLEDGEMENT OF CONDITIG"S <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> '_I expenses, or causes of action that may arise because Of Installation <br /> 1� M 1— _ —' Ct _ and maintenance of the improvement or other right-of-way use hereto <br /> l\ applied for and further agrees to remove same upon notice from the <br /> Approved for Constru Date City and to replace public property damaged thereby. <br /> FINAL IfTSPECTION Date <br /> Approved as Constructed Signature of AUTHORIZED <br /> WITHIN <br /> everelt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> © 3200 Cedar Street BE DAYS TL DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> BE <br /> Everell.WA 96201 BE DILIGENTLY PURSUED TO COMPLETION.GE O PERMIT MAY IS <br /> Phone:269.8810 CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> 1 , <br />