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Date�11L1� �^ <br />� � <br />Applica�ion For <br />PUBLIC WORKS PERMIT <br />Prin; or Type Onty <br />�� <br />Owner <br />Describe Proposed Work <br />ProjeGt Address (il known) , <br />City <br />2ip <br />ary Gp <br />aubi¢ Wo•hs Fer t• J�J ''�' ��'� <br />Biag DeO�� � _ <br />Puel¢ Works Poe <br />Tol�l Fae 5 <br />Le59A0P�-FeePd10 S <br />eaiance Dac $ �� � � <br />� y�L 3 <br />Attach lour (4) copies ol r,lana for proposed work - Draw to scale and no�e ihe lollowing as applicable: <br />• Property'.�nes • Centerline af street <br />• Outlinc and dimensions ol all existing and • Indiwte North <br />propo.,ed structures on the lot • Show any proposed grading changes <br />• Exis,ing and proposed utilities • �how measurements <br />FGRMITCONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in adaance - phone 259•881 S. <br />2. All work shall be pertormed in accordance with this permit and current City ol Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />4. This lot depends on a lift-station for sanitary sewer service. The City has <br />not accepted the lift station for operation and maintenance as of this date. <br />Occupancy of residence will not be allowed until the City accepts the lift <br />station. <br />5. Down spouts from the house are to be tight-lin�d to the curb drain. <br />6. Any grading of this lot is to be done so as not to impact the adjoining lots <br />with rain-water run-off. <br />7. Sidewalk is new and unbroken. Any damage to it will require replacement by <br />the applicant. <br />��� /?��a� <br />�ctio Date <br />;._ � �_,,._ <br />FINAL INSPECTIOM' / \ <br />^.pproved as Consiructed ��� <br />eveiet[ PUBLIC WORKS DEPARTMEN7 <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-8815 <br />ACKNOWLrDGEA1ENT OF CONDITIONS <br />ihe .n�.dersic�ned owneUapplicant hereby agree5 lo hold and save harm� <br />�e_s the Cdy of Everetl from any and all claims lor damages, costs, <br />expenses. or causes of aclion that mny arise because ol installation <br />, and icaintenance ot the improvement or olher right�ol-way use here�o <br />applied lor nnd further agrees to remove same upon notice Irom the <br />City and to repla e p li pr ty damaged ihereby. <br />� �.��� �� �a/,�/� <br />Sinnalurc ot Ppplicant � Date <br />WORK AUTH6RIZED 9Y THIS PENMIT MUST BE STARTED WITHIN <br />180 DAYS OF DAiE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIJGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAC�E OF WORK ON THIS <br />PROJEC;T UVER 90 DAYS DURATION. <br />