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Date� � <br />�UPlication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />%�Di�-/,�= <br />Mailing Address <br />� <br />� <br />, ,�,,; ,�:�,.� v.., ��S'� -/?S <br />aiae oea� • �_��,// (�,��C�i <br />ruo�¢ worb Fee <br />Totel Fae s <br />less Appl Fee Paia � <br />�� 00 <br />BaiencaDoe � <br />� ,� - D.��C <br />� /s �J � <br />rnone <br />Descr'be Proposed Work �� � _ <br />Proiect nddress �if known) �U�.�+G S— f�',(�� <br />OT <br />Attach four (4) copies ol plans lor proposed wo k- Draw to sr.alc and note ihe lollowing as applicable: <br />• Property Lines • Centerline ol street <br />• Outline and dimensions of all ezistiny e�:� • Indicate Norlh <br />proposed siructures on �he lot • Show any proposed gradinc� changes <br />• Existing and proposed utilities • Show measuremenis <br />LI <br />PFRMIT COMDITIONS <br />1. All calls for ir�:�pection shall be made 24 hrs. in advance • phone 259•8131 5. <br />2. All work shall be perform+d in accordance with this permit and cmrent Ciry ol Everelt Design and ConsirucUon <br />Standards and Specifications. <br />3. Cal! Localion Underground Service 48 hrs. be�ore )�ou dig. TCLL FREE NUMBER 1•B0�•424•5555. <br />4. ANY GRADING DONE ON THIS LOT SHALL BE DONE SO AS NOT TO IMPACT THE <br />SURROUNDING LOTS WITH RAINWATER RUNOFF. <br />5. ANY CUR6 & GUTTER OR SIDEWALK DAMAGED DURI^IG CONSTRUCTION SHALL BE <br />REPLACED BY THE APPLICANT. <br />6, ROOFTOP DO[9NSPOUTS SHALL BE T7GHT-LINED �il THE; PUBLIC DRAINAGE SYSTEM <br />p�.c.� fI /7i '✓r"tJ�LL <br />��. � <br />`—».l.i��/�c� �� .�i�7�Fi'F <br />Approved for Con truclion Date <br />(� /1�1�I�u-e�,� 7 z 3'�� <br />FINAL INSPECTION �� Date <br />Approvetl as Constructed <br />rverelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phonc 259-8815 <br />� <br />� <br />N <br />�� <br />ACKNOWLEDGCMENT OF CONDITIONS <br />The undersiqned owner,�applicant hereUy agrees to ho�d and save harm- <br />less ihe City of Everetl Irom any anA all claims tor damages. �osL <br />expenses, or causes of aclion that may arise because of ine �.on <br />and maintenance ol ihe improvemen� or utYier righl-ol-way us •�lo <br />applied for and lurther agrecs to remove same upon nolice �� ie <br />City and toJhplace public p�erry damageA thereby. . <br />S(gnature of Appl nt /� '� Date <br />WORK AUTh'O ZED BY THIS PERMIT MUST BE STARTED WITHiN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TIiEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TIIIS PERM1tIT MAY BE <br />CANCELLED BY THE CITY UPON APJY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />