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Date�"� <br />Application For <br />PUBLIC VI�ORKS PE'riMIT <br />Print or Type Only <br />C�n�,rd 19'�4 N <br />Owner <br />Sa wt � <br />Applicant <br />Desaibe Prcposec -''rorA _�1.'�.� <br />Proiec� Address (il known) � <br />� <br />na Address <br />Alailin� Address <br />, � ro� <br />City ZiP <br />Atlach lour �4) copies ol plans lor proposed work- Draw to scale and note the lollo�ving as applicable: <br />• F�operty Lines <br />• Oulline and dimensions ol 211 exislinc� and <br />proposed SlrutWras on the lo� <br />• Existing and oroposed utililies <br />PUMm wo�ks Perm�l • " `� — �/�y' <br />eieg oeu� • l4�'�� <br />PUUIrC WOiMs Fea S <br />Tolal Fee - <br />1E55 Appl F¢e Pai� S �f <br />�alanceDue $ `"x�fJ <br />• Centerline af street <br />• Indicate North <br />• Show any proposed gindi��9 chanyes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be made 24 hrs. in advance - phone 259•t3(310. <br />2. All work shall be pedormed in accordance with Ihis permil and currenl Ciry of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-R00•424•5555. <br />4. Use driveway durb-cut;; provided or get approval from the Public Saorks <br />inspector for relocation. Any new uriveway shall be installed per Cit7 <br />Standard #307. Unused drivewasy shall be taicen out an�: replaced with full <br />heighl curb and gutter. <br />5. Use storm drain system for down-spouts from roof top. <br />6. The applicanY. shall be msponsible for replacing any curb, gutter or <br />sidewalk broken during the construction process. <br />� � np <br />�� /) / � � �J`/1 i7 <br />�2i �%C�C% �� %" <br />Approved for Constru tion ( ale <br />,� . ;, <br />�' ,', ��, <br />�.���.�� <br />pINAL INSPECTIO Date <br />Approved as Ccnstructed <br />everetl PUBLIG WORKS DEPAEtMEN�f <br />� 3200 Cedar Street <br />Everell. WA 98201 <br />phone 259�8810 <br />ACKNOIM1'LEDGEMENT OF CONDITIONS <br />/ <br />W <br />H <br />�pY <br />r/ <br />� <br />O <br />� <br />N <br />O <br />a <br />The undersigned oH�ner/applicanl hereUy agrees to hold and save harm� <br />less Ihr City ol Everett Irom zny and all claims (or damages, costs, <br />expenses, or causes of aclion lhat may arise because of installation <br />and n�ain!enance ol ihe improvement or other ngnt-obway use hereto <br />applied for and further agrecs to remove same upon nolice Irom ihe <br />Cily an to replace public properiy damaged Ihereby. <br />1.1--, ,� �- if�'/t f�� /;�;��� <br />Signature ol Applicant � �ate <br />IYORK AUTHORIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERM1IIT IS ISSUED ANO THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPL[TION. THIS PERMIT MAY B[ <br />CANCELLED BY THE GTY UPON A�'Y STOPPAGE OF WOFK ON TH'S <br />PROJ[CT OVER �30 DAYS DURATION. <br />