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DateZ yd ,� <br />4pplication For <br />PUBLIC 1h�ORKS PERMIT <br />Print or Type Only W�� C�� � K <br />Pubir. Warka Parmit / `�' I":' _ v � <br />Biaq Oeol. r _�y � �' <br />PuoLc Wo�b Fee <br />Talal Fea g <br />Las� ApO� Fea Paid S <br />Belance Oue $ G�-� <br />_S� �s �.� <br />Applicant Nailing qddress O:ty Zip pn��o <br />Describe Proposed Work J'�_ 54�. � JJH�Ui <br />P�cject Address (il known) <br />Atlac h lour (4) copies of plans tor proposeJ work • Draw to scale and note the following as applicable: <br />• Property �.in=_s <br />• Outline and dim�nsions uf all existing and <br />proposed structuros on ihe lot <br />O Existing and proposed utilitirs <br />PERMIT CONDITIONS <br />• Centerline of streel <br />• Indicate North <br />• Show any proposetl c�rading changes <br />• Show measuiements <br />1. All calls fo� inspection shall be made 24 hrs. in advance � phone 259-88i 5, <br />2. All work shall be pertormed in accordance with tnis permit and currenl City of Evere't Design and Consfruction <br />Stantlerds end Specificetions <br />�. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />4, ANY GRADING DONE ON THIS LOT <br />SURROUNDING LOTS WITH RAINWATER <br />5. DOWNSPOUTS FROM THE BUILDING <br />DRAINAGE SYSTEM. <br />6, ANY �URB & GUTTER OR SIDEWALK <br />REPLACED BY THE APPLZCANT. <br />� <br />Approved as Conslructed v U <br />everett PUBLIC IYORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 98201 <br />Phono: 259-8815 <br />SHALL BE DONE SO AS NOT TU IMPACT `PHE <br />RUNOFF. <br />ARE TO BE TIGHT—LT_NED TO THE PUBLIC <br />DAMAGED DURING CONSTRUCTION SHALL BE <br />ACKNOWLEDGEMENT OF CONDITI(�NS <br />W <br />� <br />� <br />� <br />_ The undersigned owner/applicant hereby agrees to hold and save harm� <br />les; ihe City ol Eeeretl Irom any and all claims for damages, costs, <br />ezpenses, or causc�< of action that may arise because ol installatiun <br />�_� �� and mainlenance ��! the improvement or other right�ol-viay use hem�o <br />Date applied for and �u ther agrees to remo��e same up�n notice Uom Inc <br />City and to repla�c pubuc property dama�ed thereby. <br />�7th3 / ' <br />oate �"E � 3��� �'�j <br />Signature ol Applic � Uale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF UATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPIETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEk £0 DA1'S DURATION. <br />