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� <br />�' <br />��'P` OR PRINT ONLY <br />NC <br />Drscribe Proposed Work <br />� App�������on For <br />:'UBLIC WORKS PERiVIIT <br />PUBLIC WORKS DEPqRTMENT <br />3200 Cedar Street <br />Everett.WA98207 259-8870 <br />Date ���� /�� j '� � <br />� <br />Public Works Permit q�� � L <br />Building pe��t #_�� <br />, -'•� �'�JSTING �U� 18 19bc <br />' � ', .- -WCic Works Fee $ 2 �� <br />IUG�3;WQ9v�LB �vP,rP;�+.ul. nc�_� - <br />U <br />!L''�,�iZC� kY�-1 ��u4'. F�j2�in�! <br />A�e �JE�1�,, <br />�.I le�o�'tyu/, <br />��'� 7VC� � <br />PROJECT ADDRESS (if known Z �3 i�/ �b � <br />> `i— Cz,slno l:d ; �pd,,,,,,,,u„ <br />Attach four (4) copies of plans lor proposed wod, Drew to scale and note the foilowing if applicabl <br />'Property lines •Outline and dimen=ions of all existing and proposed structures on the lot <br />'Centerline of street •Indicate North •Show any proposed grading changes <br />Z�P Phone <br />��5 T�',� �._ <br />z�P � <br />Phone <br />:S `z.��OC11��0✓f$ � <br />�r-�����-- <br />-f��� � �C�kl- �., ` <br />c: <br />•Existing and pmposed ulilities <br />•Show measurements <br />PERMIT CONDITIONS: "v'v� � wrtlTE BELOW THIS LINE <br />1. All calis for inspection shall be made 24 hours in advance - phone 259-g810. <br />2. All work shall be pertormed in accordance with this permit anc current City of Everett Design and <br />Construction Standards an� Specifications. <br />�. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />I l'he old f�nk must be pntn��ed ot'product prtor to rentoval. No product or rins�: �vnter tn�v <br />bz ciisposed of in .ucl• a tvsry that it could euter the storn� cli•aina¢e ;�,steui. <br />=. TJ IIdI� 11111111111Cd dfJ"s'(JU, a���: ;poil pilzs ma;t b� COV2C2(� ��'jQl �I:L4i1C Slldcilll:� Jl' Oillcl, y <br />impen�ious co��erinG stal:ed to ILe ,q•otuid or anchored tvith rocJcs or svidba,s. <br />; R��ms, � �rthen or otlienvise. :;liould be constnutecl at the perimeter ofe�ca���ted �re;�s tn <br />pravent acliacenr site iunog'from e��teri��n the axcavation;. <br />!. T<u�l: r�uw� al 511ou1d L' a p���('orule�l dw iu,q u pz�'iod oY'e�tpectzil ilri� tivz:lllier to minimize <br />poh:nfial arosion prohkms and contmnination of�vnofftvatars. <br />�. If'contamination ofihe tiuRonnding soiis is discovered. :u�d remediation ���ill take p1�c�• <br />a�� erosion control pla�i must be suUmitted ror approval by tl�e PuUlic 1Vorks Depsitm� n[. <br />u. Aii a��plicat,lr. Deparh�iant of Lcolo¢y niles and ragulations lnust be iollo�ved. <br />7 �5 �Xx' �I��i s„bM:tted �,,��,h a I;c2{: <br />�. c���, <br />C�� Cc.n � l� <br />�� <br />NP � c�. <br />T�J`C. ��I�Z�r'�j�1C.�'.T�. {Jei��'lil. 'fc'v' A-��•C 'ii� �2+u✓��Y� <br />.,�. �-/?� Ccn Si-c r` `c�c " <br />c��-� i cr� s c-� Sel'a 's � 8Cv � Sf� ��S � <br />Approved as Constmcted <br />Z <br />O <br />V♦ <br />� <br />� <br />, <br />The undersigned o vner�pp c�anE eFe6y egree�sNolha�ld ard sa�e h.�rmless <br />the City of Everett from any and all claims lor damages, costs, expenses, or <br />causes of action !hat may arise because of instailation and maintenance of <br />ihe improvem.ent or other nght-ol-way use hereto applied for and further agrees <br />to remove same upon rotice fmm ihe City and to replac= public property <br />damagedthereby. <br />/�Pf�i ��,� C (.i'Si <br />5 J'� 9 <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 780 DAYS OF DATE PERA�t:T IS SSUEID AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />Date <br />COMPLETION. THIS PERMIT MAY BE CANCELLED �Y THE CI7Y UPON ANY STOPPAG[ Gr lh'OFK ON THIS PROJECTOVER 90 �AYS DURATION. <br />