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everett APPLICATION FOR PUBLIC WORKS PERMIT <br />Type or print clearly with ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS PERMIT NO. <br />EVERETT. WASHINGTON <br />❑ OWNER ❑ AGENT DATE / Y BLDG. DEPI. NO. <br />APPLICANT/FIRM REPRESENTED <br />ADDRESS <br />CITY <br />HEREBY APPLIES FOR PERMISSION TO — Si O e xi ,,d. <br />AT THE FOLLOWING LOCATION <br />r� <br />�w <br />iir+Is��n TELEPHONE% <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />' Property lines and street identity. <br />' Outline and dimensions of existing a;ld <br />proposed structures. <br />• Existing and proposed utilities. <br />"Centerline of abutting right of way. <br />LI <br />' Topographic changes requir(ag_cuts and fills <br />other than normal foundation.\, <br />' On -site drainage systeths when required. <br />Erosion control methods when required. <br />North arrow? <br />Signature of Applicant <br />T <br />CONDITIONS: <br />Site "Ar r— -- --- .4 <br />Approved for filling with the following conditions: <br />1• The area to be filled shall be cleared and grubbed prior to commencement of work. <br />2. Manhole/catch basin shall be realigned to coincide with new grade. Construction <br />Of the unit will coincide with filling of the area. No fill or clearing material, be alloard to enter the sewer system. Provide a typical filter fencce asrequrdlby City. <br />3. The area witI,be reseeded upon completion of this part of the project. Areas not growing by <br />May 1982 will;be reseeded again and until uniform vegetative cover is present. If, appreciable <br />erosion occurs In the opinion of the City, provisions for control will be required. <br />4. The fill is to be placed such that the final ditch line shall be a minimum of two feet <br />_ below the abutting area, and is intended to provide for a future drainage ditch. <br />5. Fill shall be placed in 1211lifts and machine compacted. No organic material will be allowed. <br />6. Any damages to existing utilities will be repaired to the satisfaction of the City. <br />-Site "Bit <br />Stockpiling of materials is allowed for future use as fill on the Department of Transportation <br />land adjacent to the easterly property line. <br />Stockpiled material will not be authorized as fill on the site it is located upon. <br />Temporary erosion controls will be provided as he un ersigned owner hereb agrees to hold and save harmless <br />required by the City. the City of Everett from any and all claims for damages, tests, <br />instaiion <br />This is not a permit for Site fB". An ind;vidual perinihdema maintenance causeion of the t improvement othat may 6BOtheruse riighhol-way use <br />will be required at the time the property is purchaseFhreto applied for and further agrees to remove same upon nonce <br />A perfomance bond or cash set -aside will be required from the City and to replace public property damaged thereby. <br />as follows: (a) $1000 for utilities protection in force until c m .letiorl of thig fill. (b <br />APPROVED FOR CONSTRUCTION DATEIhQ, fgF.5200 OonF for erosion control <br />APPROVED AS CONSTRUCTED DATE <br />re1tM11 IS VALID FOR 1 YEAR <br />EXPIRATION <br />SIG NATURE OF APPLICANT DATE <br />POST ON CALL FOR INSPECTION <br />JOBSITE 259.3811 <br />24 HRS. BEFORE CONSTRUCTION <br />