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t � <br />Date �� �`�'�� <br />qpplication FJr <br />PU63LIC WOR�S PERMIT <br />Print or TyPe Oniy <br />/ <br />Puoi�cwo,wsPc�� i%A� ��—/ / <br />Bie9 Depi.+ __L�21J� <br />PUUI�t WaikE Fea $ <br />Tolnl Fec <br />Less ADo�� Fac Paitl S � o� <br />{i�lanca Duc S _ <br />�`��}' Zip Phone <br />--t� `,'�r'-"� Mailing Address C��1' <br />Fp,h;ant n <br />" r� � <br />,.-,�. , . c�c�� r c�T ��l � ► t�2L1-�--t� � — <br />Descnbe P�oposed Work <br />Project Address (il known) <br />Altach four (4) copies ol plans for proG��sed work � Draw to sczle and nute the following as applicahle�. <br />• Property Lines • .^.entedine ol slreet <br />• Indicate North <br />• OuUine and dimensions ol all exishng and � Show any proposed gradinc� changes <br />proposed structures on the lot � Shuw mcasuremeNs <br />• Exisling and proposed ulililies <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance • phone 25b•8810. <br />2. All work shall he perlormed in accerdance wilh Ihis permit and current Ciry ol Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Undergro��nd Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800'424-55 . <br />4. Keep City streets clean at all times. <br />5. Use public drainage syatem for roof-top down-spouts• damage must be <br />G. Curb, gutter and sidewalk are new and unbroken. AnY <br />replaced/repaired by the applicant. the Public <br />7. A�Y changes to the drivcaay curb-cut muse be approved by <br />�,;crgs d� Inspector. <br />/.` / ' <br />� �fr/ O�"� .3 �J �8 <br />Approv lor Constru tion . Date <br />� - �i���Ji/ j�<<, <br />FINAL INSPECTION , Date <br />ApP�oved as Constructed <br />cvrrctl PUBIIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />[verett WA 98201 <br />PhcnC 759:'B1J <br />W <br />f- <br />� <br />N <br />�b <br />- <br />•J <br />4CKtJG.NLFf 'EM6NT Of CONDITIONS <br />7he unders��.qneo owneva[ �� �l hereby agrees lo hold and save harm� <br />less the Cily o� Ecere'1 '� iy and all claims for damages, costs, <br />expenses, or cnuses a� lhat ;nay arise Uecause of installation <br />and maintenance ot the ,�:vement or other right-oFway use hereto <br />apphed for ��ce1pubhc proPer�Yrdamaged t e�ebyn notice Irom the <br />Cii}'and ��,�' <br />( :,.=,1 �1 � c��,r..l,Lt � S S .�' <br />� — <br />Datc <br />SignaWreolApplicant - <br />,180RDAYSTOF�DATFD. P[NMISISESSLED AND THERE�FT�ER ISHTO <br />BE DILIGENTU' PUf7SU�D T� COMPLETION. THIS PERMIT MAY BE <br />CANC[LLED BY THE CITY UPON ANY STOPPA�iE OF\NORK ON THIS <br />PROJ[Ci OV[R 90 UP'� S DU'��1TION <br />