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Dates=� �s� iS <br />Application For <br />PUBLIC V�lORKS PERMIT <br />Print or Type Only <br />i��, <br />Owner <br />� 1 �3 <br />. . �.io�� ny n�wa56 <br />Describe?roposed Work ��� C"��9-t.J <br />Projecl Add�ess (il known) <br />PuCiic Worka permp � a/ O� Cl � <br />BIC9. Dept • �� � /� <br />�ii� Works Fee <br />TotalFee S______,_ <br />Lass Rppt Fea PaiU S__ <br />Baiance Duo S � V � <br />��0�0 <br />AUach four (4) copies of plans lor proposed wo-k - Draw to scale and note ihe lollowing as applicable: <br />• Property Lines • Centeriine of streel <br />• Outline and dimensions of all existing and • Indicate Norih <br />proposed strdctures on the lot • Show any proposed gratlir.g cha�ges <br />• Existing and �roposed utilities • Show measurements <br />PERMIT CONDITIONS <br />�76 2 <br />Phone <br />Phone <br />t. All calls for inspection shall be made 24 hrs. in advance - phone 259-8815. <br />2. All work shall Ge per(ormed in accordance with ihis permit and currenl City of Everetl Design and Construction <br />Stan�aras and Specilicalions <br />3. Call Location Underground Service 48 hrs. before you tlig. TOLL FREE NUMBER 1•$00-42Q•5555. <br />4. A[�Y GRADING DONE ON THIS LOT SHALL BE DONE SO AS NOT TO IMPACT THE <br />SURROUNDING LOTS WITH RAINWATER RUNOFF. <br />5. DpWNSPOUTS FROM THE BUILDZNG ARE TO BE TIGHT—LINED TO THE PUBLIC <br />DRAIeIAGE SYSTEM. <br />6. AN� CURB & GUTTER Ok SIDEWALK DAMAGED DURING CONSTRUCTION SHALL BE <br />REPLACED By THE APPLZCANT, <br />3 ��7 <br />Approved as Constructed v � <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Ererett, WA 98207 <br />Ph.oe:259-8815 <br />ACKNOWLEDGEMENT OF CON�ITIONS <br />W <br />� <br />s <br />� <br />The undersigned owneyapplicant hercoy agrecs to hold and save harm- <br />less the City ol Everetl Irom any and all claims lor damac�es, costs, <br />expenses, or causcs ol aclion that may arise her.ause ol installation <br />and maintenance ol the improvement or other righbol-way use hereto <br />applied lor and funher agrees to remove• same upon notice from the <br />City['a�nd to replace public property damaged Ihereby. <br />V l�C,� ���,��^�-C`7�--- .YIZ Op <br />Signature ol Applicant Date <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTE� WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLeD BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />