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R <br />� <br />evcrett APPLICQTION FOR PUBLIC WORKS PERMIT <br />� TYPe or print clearlY with ink <br />PRESS HARD • YOU ARE MAKING COPIES pERPd1T NO. $1/297b <br />PUBLIC WORKS ____�, <br />EVERETT, WASHINGTON BLDG. DEPT. NQ. <br />❑ OWNER � AGENT DATE , Z�z3�82 _ <br />_.. <br />APPLICANT/FIRM REPRESENTED Bill Rc�ineon <br />ADDRESS 607 S.E. Everett Mnll Slay ' CITY Everett TELEPHONE <br />HEREBY APPLIES FOR PERMISSION TO _ inetall 24" culvert and two Type II Catch Sasine <br />aud fill property in accordance with plane for , <br />ATTHE FOLLOWING LQCATION __ S.W. Corner of Everett riall Way 6 Ith Ave. <br />Attacn five (5) copies of preliminary plans for propos?d work. Draw to scale and show the following as applicable: <br />. , � . � <br />* Property lines and street identity. * Topographic changes requiring cuts and fills <br />* Outline and dimensions of existing and other than normal foundation. <br />proposed structures. " On-site drainage systems when required. <br />* Existing and �roposed utilities. * Erosion control methods when required. <br />* Centerline of abutting right of way. ' North arrow <br />' I/isiVi..c�— �--�� /Cy' �. <br />PUBLIC WORKS PE <br />CONDITIONS: _ . _ <br />f *.Eill 1n accordance with apptoved plane dated 10-28-81, . <br />�i. <br />j'* Cu1VerC pipe 'aill Be insEallc@ per plan. <br />� � At time of p'roperty development - property o�.mer will be liable for either: <br />�__ <br />�:_ ,.(1) Provide on site Jetention to include.the area bein� filled "012" <br />I- '(2}' Paymsnt info'rhe Water Facility Fund; a fee based apon Che loss of ; <br />;... .. 15U0 cubic feet of n�tural ponding. ; <br />�I` (1'& Z'a're iii addition to othet developmen[ 'reyuirements.) ' ��� �. <br />_ ,. :.. <br />' _ . _ . . _ . ._.. .___. ..,. . <br />� .. . . _ i ,�. __ . <br />� i � <br />: 1 , . � , 1 . ..�� j .. <br />�' _ <br />`.. '. . . . �. : . .. . . ! :. : . . .. :. t . . ': � <br />I � . . j . <br />� _. . . . . . � . . . . . . � . - �� � . <br />_. I . � ' . , . � `. ,�'��,. <br />1._ ._. ' �... ... . ,__ _ ...... . . ........._. <br />'�.. . . , . . . . . . . . �. . . _ . . , . . . . ... . <br />i � i i /�_ �� <br />7. � � o i//,f'" � J–� O� <br />PEFiMIT 15 <br />�__j EXPIRATION <br />FOR 1 YEAR <br />-2�^"�'.�- <br />The undersigned owner hereby agrees �o hold antl save �armless � <br />ihe Cily ol Everelt trom any ana all claims br damages, costs, <br />expenses, or causes of action that may arise because ol ins�a�lation i <br />antl mainlenance of ihe improvement or olher riBh4ohway use �, <br />here�o applied for and lurther agrees to remove same upon noNce <br />Irom lhe City antl to rePlace public proDerty damaged thereby. � <br />ACKPIOWLEDGEMENT OF CONDITIONS <br />J � <br />li �.� =�r�� =�-- ;; , <br />SIGNATUREOFAP LICANT DATE - <br />CALL FOR INSPECTION � <br />POSi ON 259-8811 <br />JOBSITE 24HRS.BEFORECONSTRUCTION ' <br />_ -- ----- -- � <br />