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oe�a '_� . _9U <br />Application Fo� <br />j � ' PUBLIC WORKS PERMIT <br />Pr!nt or Type Only <br />L2 G( <br />% �. <br />Cny <br />PuOfcWoresPsrmi � ��17�—�� /' <br />tnea oem . � ' Lf— <br />Puebc Worb fea <br />Tow Fee S — <br />Lae� �po� Fee P�ia S <br />B�IancaDue s � <br />Apnlicant Meiling AAdress 1:ily Zip Phone <br />Dencribe Proposed Wark <br />Pro�ect Addreas 111 known) <br />Atlach four (4) copies of plene lor proposed work • Draw to scale and no�e tha I011owing aa applicable: <br />• Property Lines • Cenlerline of street <br />• Outline end dimanaiona ol all existfnp end • Indicate Norlh <br />proposed elructures on ihe lol • Show eny propoaed g�ading chenges <br />� Exiatlnp end proposed utilitles • Show moasuremenls <br />PERMIT CONDITIONS <br />1. All celle for Ine.pectlon ehell be mede 24 hre. In advence • phone 259•881 Q. <br />2. All work ehell be peAormed In eccordence with thla permit end cu�ent City of Everett Daelpn and Constructlon <br />Standarde and Speclllcatlone. <br />3. C_.� Locallon Underqround Servlce 4B hra. belore you dip. TOLL FREE NUMBER 7•600�424•5555. <br />4.ANY CHAN(iB JN THE DRIVhWAY CUT MUST BS APPROVSD <br />BY THE PUBLTC WORRS INSPfiCTOR. <br />S.CONNHCT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTfiM. <br />B.RSHP CITY EiTRHRTS CLSAN AT ALL TIMSS. <br />7.ANY DAMAl36 TO THS CURB AND SIDisWALK WILL SH REPAIRHn <br />TO THS SATISFACTION OF THH PUBLIC WORKS DSPT. <br />�c�.•�. M�k�. �-Z4—�o <br />Approved lor Const�uctlon Dnto <br />1��� � -a t'- �� <br />FINAL INSPECTION Dale <br />Approvod ae Constructed <br />evr.rett PUBLIC WOHKS OEPARTMENT <br />� 3200 Ceder Sheel <br />Eve�ett, WA BB2J1 <br />Phona:25B�8B10 <br />ACKNOWL[DGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned o��ner/an�l�^ant hereby ogreea to hold and seve harm� <br />less Ihe Gty of Evere�t I�an sr�v and all claime lor dameges. cosls. <br />eMpenses, o� ca��es o� action tl,•t mey erise because oi Installatlon <br />end meinlenance ol lha imprcrCnent or olher righl-of•way uee hereto <br />applled for and further a�rees W remove same upon notice Irom Ihe <br />City and to replace puhll�: property damaged ihereby. <br />Signature ol Applicnrt ua�e <br />W09K AUTHORI2ED BV THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERA7IT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTIY PURSUED TO COMPLETION. THIS PER�AIT MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />