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oato�°�9� =' <br />PUBLIC <br />Pr(nt or Type Only <br />� <br />J -12-28-�- <br />Applicatinn For <br />NI�ORKS PERMIT <br />� Tp(1 P(15TING p�'��''�"a ., <br />r: i�i��i � �r�rn'- r-� rif�v' <br />4 �OC O �+�? O V7 [Ci0[- <br />Ci O In �O .�+ �A [�.1 O �� b) I'; <br />d d� M M �A -+ � q r•; <br />CI _ _ !R _ _ H' M .- <br />� G� <br />ng AddreH z [Q- j� oi �71IY, <br />L� ( I W �J � 7 pLJ FQ- p� I� � <br />Il! �. � d fi1 C] �C 3��.1 C.1 <br />Malling <br />Deacribe Propoaed Work 'y'Sr r� <br />Pro�ect Addrese pl knownl � ' <br />P��,�W�,.,P,.mi,. 9� Z�� . <br />eia� cs,r . _ �I 2%2Z,0 <br />f o[br. Ylor4 Fae <br />To�line i <br />� ir�sAoai q�e ^ua 6 -7 <br />4ai�n�.x O��e S L� � . <br />� --- <br />��S �.58 3343817 <br />Z�P Phone <br />Altach four (4) copiea of plens lor pioposed work • Draw lo ecale end nole Iha Iollowing as epplicable: <br />• Property Lines • L'enterline ol slreet <br />• Oufline and dlmenslons ol ell axlstinp and • Indicate North <br />proposed st�ucturea on the lol • Show eny proposed greding chanpos <br />• Existing ond proposed utllitles • Show meesuremenls <br />� <br />PEqM1T CGNDITIONS <br />1. All calls for Inspection shpll be made 24 hre. in advance • phone 259•8810. <br />2. All work ehell be perlormed in accordance with thia permlt end current City ol Everett Deaign end Conatruction <br />Slanderds i md Speclllcationa <br />3. Call Locatlon Underpround Servlce 48 hra. belore you dip. TOLL FREE NUMBER 1•800•424•5555. <br />4. Inetall rock conetruction entrance behind drivewav ae per city <br />etandard ri208 and eroeion control as directed by Public Worka <br />Inepector. <br />5. Keep ciiy atreete clean at all timee <br />8. Curb �utter end eidewalk in the plat are new and undrima�ed, <br />anY daunage thereto ahall be replaced at the diacretion o£ the <br />Public Worka Inapector. <br />7. Any change �.n the drivewa,y cut muet be approved bY the Public <br />Worka Inepector_ <br />B. Tightline ell roof, yard and driveway draine to eY.orm drain <br />etube at back eide of eidewalk. <br />9. Ad,ivet water hoxea to grade at end of conetruction. <br />10. Di�fveway� ehall be complRtely cured before drivinq on them. <br />o�,�� <br />� � � <br />�a-�-R � � �- �-"L - 91 <br />Approved for Cone/tr�uction Dete <br />� `�"' / •�7'f�7� <br />FINA P� Data <br />Approved as Constructed <br />PUBLIC WOFKS I7EPARTIAENT <br />3200 Ceder Street <br />Everelt, WA 98201 <br />Phono:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />�� <br />� <br />W <br />� <br />1� <br />� <br />� <br />O <br />The undersigned owner/npplican� hAreby agrees to hold end eave hnrm� <br />lesn Ihe Ciry ol Everell Irom any and ell clalms lor demegas, costs. <br />eMpnnses, or causes of action Ihal may eriso because ol Instellatlon <br />anrl main�enance ol the improvement or other right-ol�way use hereto <br />epplieC for nnd 1 rther egrees lo remove seme upon notice Irom the <br />Ciry and to �a publ� pro erty tl maged lhereby. <br />gnatur 1,1pplicanl Date <br />ORK THORIZED BY THIS PER�AIT N.UST B[ STARTED WIIHIN <br />180 DAYS Of DATE PEFMIT IS ISSUED AND TM�HEAFTEH IS TO <br />BE DILI6ENTLV PUR.SUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCF.LLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />