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ynH <br />��9� <br />,O�1x <br />C H <br />�Hcn <br />H�� <br />K o <br />H xl <br />,o�xo� <br />y tn <br />th y � <br />O H <br />H�,g <br />� Y (] <br />t"yZ <br />I--� y <br />t7 rn <br />c�] 17 fA <br />� � C�1 <br />ZHtn <br />HOCn <br />Date1— /� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />��5�/ <br />Applicant <br />i0 POSTING <br />Zip <br />Puo�lc worxe peimN . �� w� / <br />eiao ocoi.• <br />Puoiic worxa Feo <br />TolalFee S <br />Less Appl Fec Pa�d $ <br />Baiance�ue 5 z�^ <br />3//o/q3 <br />Describe Proposed Work OY�r1�G B�� /ZG/fl�2GC r—vG� ��.�t ,� <br />Proj�c� Address (it known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as apPliwble: <br />• ProperP� Lines • Centerline ol s�reel <br />• Oulline and dimensions ol all exis�ing and • Indicale Nor�h <br />proposed structures on the lot . • Show any proposed grading changee. <br />• Exis�ing and proposed utilities • Show meas�rements <br />'��' PERMIT CONDITIONS <br />7. All calls lor inspection shnll be made 24 hrs. in 2tivance - phone 259•8810. <br />'' 2. All work shall be pedorme:l in accordance with this permit and current Ciry of Everett Desipn and Construction <br />Standards and Specifications. <br />�' 3. Cali Location Underground Service 4B hrs. before you tlig. TOLL FREE NUMBER 1•800•424•5555. <br />i"� <br />►_i <br />4. The ald tank auet 6e puoped of product prior to teooval. No praduct or <br />rinae vater say be dieposed oE in such a ray that it caald enter the <br />atorn drainage eyate�. <br />5. Ro help olnioiae eroeion, anp epoil piles ouet he covered with plaetic <br />eheeting or other i�pervioue covering etaied to the grauad or ancAored <br />xith rocka or sandbage. <br />6. Beros, earthen ar otEerxiee, ehould be conetructed at t6e perioeter of <br />excavated areae to prerent adjacent eite runoff tron entering the <br />excavaEioos. <br />7. 7ant reeoval ahould 6e perforeed dur:ng a period of expected drp <br />weather to uini�lze potential erosian ptobleos and contasination of <br />runoff ratere. <br />8. If contaeinatioo of the eurrounding eoils ie diecorered, a�d <br />ACKNOWLE�GEMENT OF CONDITIONS <br />W <br />H <br />� / <br />Z <br />O <br />♦�� <br />V ♦ <br />O <br />a <br />[@OBd17t10� xill take Qlace, an eroeion control plan euet be eu��t�P�ders' d w / I' �h r b r � h Id d h <br />9. 611 applicabl epartnent of Bcology rulee and regulationa ■ <br />follored. � (�/LC—(�Q �_(P—�3 <br />Apprwe/s �f /yr Consiruction Date <br />J �.,4�e.ct--L— �///"� <br />FINAL�INSPECTION ' Date <br />Approved as Constructetl <br />PUBLIC V�ORKS DEPARTMENT <br />3200 Cedar Street <br />"n Evere�t,WA982Ui <br />Phone:259�88+0 <br />it�ne o ner app iCan e e y ag ee5 0 o an save arm- <br />- less ihe City ol Everelt Irom any antl all claims lor damages, cos�s. <br />C bCpenses, or causes of action ihat may arise because ot insiallation <br />and maintenance of ihe improvement or other riqhFohway use hereto <br />applied for and lurther a9rees lo remove same upon notice Irom ihe <br />Cily and Se�replace pub6c properry damac�ed thereby. <br />/ 1 <br />f / <br />-�ti«,� 1 �,��_ /f � �/� <br />Signature of q/icant '� Date <br />WORK AUTHdfiIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY Br <br />CANCELLED BY THE CITY UPON FNY STOPPAGE OF WORK ON TN <br />PROJECT OV[R 90 DAYS DURATION. <br />