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-- ,.._ <br /> 2 ' ^ ��,, �� � <br /> Data_1�d � Pu�I�c Wo�Ms Pximn�a �� <br /> Application For _ oiaq oeo� •_-.� / ' � <br /> PUBLIC WORKS PERMIT Pu�l¢Wo�kSFOC — — <br /> Total fce S-- <br /> lesa ApO�.Fee Pa:E 5---y�-- <br /> BaianceDue S <br /> 4� � <br /> Prirt or Type Only <br /> -���-�' �, / 70l� •-/Sf G� I� sP� ff� �e ��P/ SS 3G.����r _ <br /> Owner Mailing Atldress City Lp Phone <br /> ) I] A ^..A <br /> Applicant Mailing Address City Lp Phone <br /> Describe Proposed Work �L �� <br /> �_.fd�-"-�Q <br /> /� W <br /> PmlectAddress�ifknown) /�J'�'2�— �����/yGF `SF � <br /> Attach four(4)copies ol plans tor proposed work- Draw to scale and note ihe'ollowin�as applicable: � <br /> • Propert7lines • Centerline nt street ♦A <br /> • Outline ani dimensions ot all existing and • Indicale North V� <br /> proposed�Aructures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•88'1 5. � <br /> 2. All work shall be perbrmed in accordance with ihis permit and current Ciry ol Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 40 hrs.bebre you tlig.TOLL FREE NUMBER 1-800•424•5555. � <br /> 4. ANY GRADING DONE ON THIS LAT SHALL BE DONE SO AS NOT TO IMPACT THE O <br /> SURROUNDING LOTS WITH RAINWATER RUNOFF, <br /> 5. ANY CURB & GUTTER OR SIDE{QALK DAMAGED DURING CONSTRUCTION SH�LL BE � <br /> REPLACED BY THE APPLICANT. <br /> 6. ROOF—TOP DQWNSPOUTS ARE TO BG TIGHT—LINED 'PO THE PUBLIC DRAINAGE SYSTcM. �/♦ <br /> O <br /> a <br /> ACKNOV:LEDGEMEiVT OF CONDITIONS <br /> 7he undersipned owner/applicant hereby agrees to hold and save harm� <br /> �ess the Cily of Everett Irom any and all claims for damages, cosis, <br /> � expenses. ��r causes ol action ihat may a�ise because of installation <br /> '� � and maintenance ot the improvement or olher righPof-way use hereto <br /> � �'�� ���� -� ?'�/�4' applied for and lyuther agrees to remove same upon notice Irom lhe <br /> Approved tor Co struction Ddte City and to rep �ce puhlic prope� amaged th�reUy. <br /> C-� ���,� z l� L �7 , <br /> FINAL INSPECTION Date �� � � � <br /> Approved as Constructed S nature ol Applic� � �a� <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE ST;� '.'. J WITHIN <br /> everett PUBUC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEE ' "ER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COMPLETION. THIS F'EHMIT MAY BE <br /> EveretL WA 38201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TI IIS <br /> Phone: 259�8815 PROJECT OVER 90 ��4YS DURATION. <br />