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Date� -22._;fr$ <br />ApP�ication For <br />PUBLIC WURKS PERMIT <br />Print or Type Only <br />Mailing <br />Ciry <br />Puoiic Wrv.a Peimn . (� <br />� c - /7�= �--" <br />plEp. OOpI. s ��y� S <br />PuEi¢WaruFee 5 . <br />ToialFee <br />Leaa Aool Fee PnE $ <br />Baianceoue 5 GD�D <br />�A.0 P <br />Applicant Mailing ACdress Ciry . ZiP Phone <br />Descnbe Proposetl Work <br />Pruiect Address Iil known� f�J�/S —.� � d �.P S'E . <br />ht:acn tour (4� copies ol plans tor proposed work • Draw to scale and note Ihe following as applicahle: <br />• Prooerty Lines • Centerline of streel <br />• Outline and dimensions of all exi,ting and • Indicate North <br />proposed structures on the lot • Show any proposed gratling changes <br />• Existing and proposetl utilities • Show rccasurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in accordance with this permi; and current City of Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1•800•424-5555. <br />�.;;hil' CHr^,I�IGc IN THE DRIVEWAI' CiJT ML�ST 6E AF'F'ROVF_L� <br />E`i THE F'UBL?C WOFk::S DEFARTMLLIT. <br />S.USE FUEEL?�� ^RAINA6E SYSTEM AS FF.OVIDED FQR DOWNSPOUTS. <br />G. AN`r LOT GR(�GE CHANGES MUST PE AFFf-:OVED �Y THE <br />P�J!�LIr_ WOFI:S INSF'ECTOF.. <br />i.1:EF_P CITY STFEETS CLEAN AT ALL TIMES. . <br />,- ' <br />C �— <br />i -' , - . <br />' � �'�%l' ca� : . <br />- � !�� <br />, . �y� � <br />�':crJ L� �� ;� <br />,� � <br />f� �� t � � , �� �����,,� ' <br />evereR PUBIICWORKSDEPARTMENT <br />� 3200 Cedar Street <br />Ev�ret4 WA 98201 <br />Phune: 259-8870 <br />W <br />� <br />� <br />Z <br />O <br />�� i ��� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less Ihe Ciry of Everett Irom any and ali claims lor dama9es costs. <br />expenses. or causes of action that may arise because uf installacion <br />and mamtenancc of the improvement or other ri9hhohway use hereto <br />applied tor and further agrees to remove same upon noUce Irom the <br />Ciry an to replace public properry damaged Iherehy. <br />11—�' ,� �viw�- s � �� <br />Signature ol Applicant �- Date <br />Y10RK AUTHOflIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />18U DAYS OF DAi�E PERMIT IS ISSUED AN� THFpEAFTER IS TO <br />BE DILIGENTLY PUliSUED TO COh1PlETION. THIS PERMIT MAY BE <br />CdNCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS <br />PFOJECT OVER 90 DAYS DURATION. . <br />