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o��e.3l.f �,3�Ai <br />Applir.ation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�{'N E <br />Applicanl <br />Descriue Proposnd Wurk <br />i'„i , ri,,,�. r�(. '�..i �� I ' %L; <br />n��i�� nrn� . _7�.� � yi�.J_�—. <br />� �,�,-���-wo,—., F�e _ � -- <br />,��„� ��,. <br />l rss npn� rrc � a�a S <br />tdailingAddrress G�Y Z�P f�E�� �l��i�� <br />MELH i90.00 <br />e sscH b4.so <br />MnilinyAddu�ss City Zin �t � e <br />WRiER i130.OQ <br />Prolect AdUress UI knownl ��, �1 SL� `�. ��v CASH SU.50 <br />CHNG . <br />Attach lour 14� conies ol plans br proposed work � Draw lo scal�� and nole the following as applir,ahle� <br />• Property l�nes <br />• Uitlime and dimenslons of all ex�stinp anA <br />pwposed slrur.tures on Ihe lol <br />• Eaisling nnd proposeA uldi�ics <br />• Cr.nledine ol street <br />• Indir.ate North <br />• Show any pronosed yradm9 chan�r.s <br />• Sho1v 1➢eaSUrem9015 <br />PEHMIT CONDITIONu <br />I. All calls lor inspection shall be made 24 hrs. in advanco � phone 2rJ9•88� 0. <br />7. All work shall be perlormed in accordance wilh this permil and cwrenl City ol Fverett Desipn anC Construclion <br />Standards and Specifications. <br />3. Call Locution Underground Service 48 hrs. belore you dig. TOLL 1-REE NU nBER 1•800•424•5555. <br />4. I�stall rock r_onstruction entrance behind driveway as per city <br />standard N20B to reduce tracking mud onto streets and erosion <br />control as directed by Pubtic Wor�:s Inspector. <br />5. Keep city streets clean at all times. <br />6_ Curb, gutter and sidewalk in the plat are r,ew and undamaqed, <br />any damage thereto shall be replaced at the discretion oi the <br />7. <br />FJ . <br />9. <br />10. <br />c� <br />Fublic Works Inspector. <br />Any chnnge in the driveway cut must be ap{�roved by the <br />Fublic Works tnspector. <br />Tightline all roof, yard and driveway drain� from houses to stor <br />drain stubs at back of side walk with rubbF•r gasAet F.V.C. pipe. <br />Adiust water boxes to qrade at end o? cono�ruction. <br />Driveways shall be completely cured before drivinq on them. <br />ACHNOWLEDG[MENT OF CONDIL(�Nti <br />�4�`�.,�I'�`Ka�— 2-LS-:3� <br />Appiovnd lor Co C�iOn/ Date <br />. �� 1-��--- G i�- �i <br />FINl.L�INSPECTIO n���' <br />Ap���ovad as Construcfed <br />rvrrrlt PUBLIC WORKS DEPARTMENT <br />� 3200 Gednr Street <br />Evmelt, WA 9B201 <br />Phone�. 2.`9�At310 <br />W <br />� <br />N <br />1� <br />� <br />� <br />N <br />O <br />a <br />Tho undeioignetl ownm/aPPhcant hr�icbY �9�ces lo hulA anJ save h.�nm <br />I�ss Ihe Cdy o� h.rret� Irom any and all claims I,r Aama9es, cosls. <br />eMpenses, or causes ol �clion that may nrise Uecause ol installahon <br />and mamtei•ance ol Ihe improvement or o�he� n{�M ol�way usr. herrlo <br />applind Inr and lurthei a�pe�,s �o rrmnvc sam� uPon nolice Irom Ihc <br />Cdy 'ind lo mPlace Pubhr.. PioPr�'Y damni A ihereby <br />�._� .--- <br />,�,��,: �,� :, � : ,,,�, _ <br />h M 11Q IZCD fiY iN15 P[HMIT MUST OE STARTC� WI�HIM <br />1(30 DM'S OF DATE Pf�:RMIT IS ISSUED AND TII[REAFTER IE TO <br />B[ DILIG[NTLY PURSUE� TO COMPLETION iHIS PEHMIT MC.V BE <br />CANC[LLED BV iHE CITV UPON ANV STOPPAG[ OF WORK OP THIS <br />P170J[C1 OVf_f7 90 DAVS DURATION <br />