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Date.�J27�91 <br />Apphca�ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�� _� . <br />, ,.,,�.. ,,, .,.. ,,.,, _ . � - - <br />oiny �eni • _91/2b7Q3_ __ <br />ruo�m Wm�e rrr <br />roinir.e S <br />Lrv nnni �v. �e�n S <br />Aaian�r I'ii S � <br />Dujardin Dev. PO Box 5308 Everett 98206 334-501li <br />�wner Moiling Address City Lp Phone , <br />��uC'�iLF� <br />Applicant <br />Mailinc� Addross <br />dy Zip Phone <br />Describe Proposed Wo�k __�onn r �r nrw cin�+�f�¢�y_rn^i�,�e _ <br />Pro�ect AAdress lit knownl <br />21 - 75th St SW <br />�z <br />AIIm3i lou� I�) Copies ol plans lur proposed wo�k � Draw to scale anA nota Ihe lollowin9 as apP6cable <br />• P�opeity L�nes <br />• Outlint. and Aimensions ol all exislin9 and <br />propostd sirue�ures on Ihe Ioi <br />• [xisting and proposed uldities <br />r� <br />6 <br />,� <br />� <br />q <br />10 <br />• Center6ne al sircet <br />• Indir.ate Norih <br />• Show any proposed yrading chanqi�r, <br />• Show measuremenls <br />PERMIT CONDITIONS <br />1. All cells lor inspeclion shall be made 24 hrs. in ndvance � phone 2S9-BBi 0. <br />2 All work sh.all be peAormed In accordance wilh this permil and currenl City ol Everetl Design nnd Conslruction <br />Standards and Specifications. <br />3. Cnll Locetion UndergrounA Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />Inetall rock conetruction entrance behind driveway ae per city <br />ntnndnrd #20B t:o reduce tracking mud onto :.treete and eroeion <br />control nn dir�cted bY Pub]ir. Worke inApo�:Y.or. <br />Keep city �atrP�Y.n �lc��-�n at all timeae_ <br />Curh, �utter and r�id�sralk in the plat are new and undamnged, <br />any dama�e ther�to �hnll be replaced at thR diecraY.ion of i:h� <br />Public Worke innpector_ <br />Any change in the drivAway cut munt ba epprovad by the <br />Public Workn Inepoctor. <br />Tightli.no .�17 roof, yard end drive�v►ay dra]un from houaeA to etorm <br />drain eY,ubn at back of aidc� walk wiY.h rubF�,r gaeket: P_V.C_ pipri. <br />Adjuet water boxee to gr:�d� aY, ond of coneY.ruction. <br />Drivewaye ehal.l be comple�t:�l.y cured before driving on them_ <br />��� w� `�- �8-�_ <br />Approved for Constr) CUon Dale <br />1l /� y <br />�ei' �C- / '%' O , - �� <br />.� � <br />RNAL INSPECTION Dale <br />Apn�oved as ConsVuded <br />rvprrt� PUBLIC WORKS DEPARTMENT <br />� 3200Ceda�Sireel <br />F:verelt, WA 98201 <br />Phone 259�9(it0 <br />ACKNOWIEDG[MLNT OF CONDITIONS <br />W <br />� <br />_I <br />� <br />O <br />� <br />N <br />O <br />a <br />The undersi{lned ownci/aPPhcanl hrrebY �9rees lo hold and save ha�m� <br />���ss Ihe Cdy ol F• �re�t I�om any anA all Claims Im damae�es, r,osls, <br />erxpenses. or c'.ase,s ol nchon that may anse brcausrt o� mslallation <br />and mainien2nce ol Ihr, miprovement or other fIt�FIbO��Wify USP. hP,/C10 <br />�nn����d �or and iurmer aqrees to remove same upon nu�ice Irom �he <br />CitY ����1 to rePlare public proPrrtY damaged therebY. <br />Signalu1c o' �1P ir.ant ��C!//�C'�Z (/ Date <br />WOFiK 4UTHOf712ED BY THIS PERMIT MUST OE SiART[D WITHIPI <br />190 D�YS 01- OAT[ PFRMIT IS IStiUED AND THEREAV iFR IS TO <br />BE DILIG[NTLY PURSUEU TO COMPL[TION THIS PERMIT MAY BE <br />CANCELL[D BV THE GITV UPON ANY STOPPAG[ OP WORh ON THIS , <br />PR(7.ICC1 OVU190 UAVS UURATION ; <br />