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1 <br /> l <br /> i <br /> —1 za 4 3q� <br /> Date <br /> pias o.rd.niz <br /> b s . Appiic.rtlon For <br /> M PUBLIC WORKS PERMIT NbM <br /> To feerpe s. <br /> •'1 y L.e,A,,%Fee Pud S <br /> K y Bxi,rKe Me <br /> y Print or Type Only <br /> s � nwczx� q�o�� syr�rJ <br /> 0 t f �t r„F1-JIBS �j �' 1C�3 a <br /> S A O IA l l Y 11 Zlp Phone <br /> .. tc p Me�ling Address <br /> n , n Owner <br /> ., <br /> Z H <br /> Z CITY Zip Phone <br /> N H Applicant Mailing Address <br /> 8 r <br /> fY O N <br /> td t. Describe Proposed Work <br /> �l. U <br /> O Lon <br /> Project Address 111 known! <br /> 13-C) — Ca i s-T- <br /> Attach lour(4)copies of plans for proposed work• Draw to scale and note the following as applicable: <br /> • Property Lines North Centerline of street Cn <br /> • Outline and dimensions of all existing and • Indicate ro <br /> proposed structures on the fol • Show anyy proposed grading changes <br /> • Existing silo proposed utilities Is Show measurements /0 <br /> 00 NOT WRITE BELOW THIS LINE 09%06/911 - <br /> 0 <br /> .� PERMIT CONDITIONS <br /> L 1.All calls for Inspection shall be made 24 lira.in advance•Poona 259.8810. 1'' - � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Cnnstr, <br /> I no <br /> Standards and Specifications. $45.00 <br /> 3,Call Location Underground Service 48 fire.before you dig TOLL FREE NUMBER 1.600424.5555.$60.00 <br /> '.� 443.80 <br /> d S(iGH 44.;i0 O <br /> 4.ANY CHANGE IN THE DRIVEWAY CUT MUST BE APPROVED DRWI 4^0.00 <br /> BY THE PUBLIC WORKS INSPECTOR. #00006987 <br /> 5.CONNECT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. WATER 1105.00 <br /> S.KEEP CITY STREETS CLEAN AT ALL TIMES. 1100027914 <br /> 7.ANY DAMAGE TO THE CURB AND SIDEWALK WILL BE REPAIRED SEWER 430.00 V♦ <br /> TO THE SATISFACTION OF THE PUBLIC WORKS DEPT. M0 1 4110.09 <br /> I 1171-5 4650.00 <br /> CHECI; 41617.80 A <br /> !I ' ACKNOWLEDGEMENT OF CONDITIONS <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 /> expenses. or causes of action that may arise because of installation ' <br /> and maintenance of the Improvement or other right-of-way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved for Construction Date City and to reepllaccee public property damaged thereby. C, <br /> FINAL IPEC(ION Date Dale <br /> Approved as Constructed Signature AUTHORIZED of BY THIS <br /> RMIT MUST BE STARTED <br /> eve Il PUBLIC WORKS DEPARTMENT <br /> 1BODAYSOF DATE PERMIT ISEISSUED AND THEREAFTER ISTO <br /> u 3210 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION,THIS PERMIT MAY BE <br /> Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259.8810 PROJECT OVER 90 DAYS DURATION. <br />