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Date�� <br />Application For <br />P�16LIC WORKS PE�RMIT <br />Frint or Type Only <br />Mailing <br />PoLI¢ Wo�Ms Parmil �p y �_/� � _ <br />Biag Oeo� � �{ �� / �� <br />PUEI¢ Workg Fee s <br />Tolel Fee <br />lass ApO� Fee Peio S�'y <br />Balanro Due S v <br />. 3�o3-Q�/ti <br />Phone <br />Lp YhonC <br />Proiect Address (if known) <br />Altach lour (4) copies of plans lor proposed work - Draw lo sccle and note Ihe following as applicable: <br />• Propei,y Lines • Cenlerline ol street <br />• Outline and dimensions of all existing and • Indicate Nor�h <br />proposed structures on ihe lot • Show any proposed grading changes <br />• Existing and proNosed utili�ies • Show measurements <br />PERMIT CONDITICNS <br />1. All calls br inspection shall be made 24 hrs. in advance • phone 259•881 S. <br />2. All work shall be performed in accordance with this permit and current City ot Eve�ett Design and Construction <br />Standards and Specifications. <br />3. Call Loca�ion Underground Service 48 hrs. helore y�ou di�. TOLL FREE NUMBER 1•800•424•$555. <br />4. ANY GRADING DONE ON THIS LAT SHALL B6 DONE SO AS NOT TO IDIPACT THE <br />SURROUNDING T,OTS WITH RAINWATER RUNOFF. <br />5. ANY CURB & GUTTER OR SIDEWnLK DAMAGED DO�ING CONSTRUCTION SkiALL BE <br />REPLACED BY THE �1PPLICANT. <br />�-�^. .C�OOf'TOI' 170cc�.Us"r�Oc-':S ''%E� To fjE Tc�f1.--C,���"U TC� <br />T f r��FiG iL f%2h'�niAGr S�/3�Te.'n� . <br />___��/i <br />/ /�!�/ d��'�'—"� c_.�/l.s/ri�C'' <br />Approved for Construclion Date <br />_ _IAL/���'U"�'/lA/vv � �/��C•J%, <br />FINAL INSPEC`�YION Date <br />Approved as Cor.strur,ted <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />EveretL WA 98207 <br />Phone:259-8815 <br />ACKNOWLEDGEMENT OF CONDITIGNS <br />W <br />� <br />_ / <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ownedapphcanl heieUy agrees to hold and save harm� <br />less Ihe City ol Everetl Irom any and all claims lor damaaes, costs. <br />expenses, or causes of action that may arise because o� installation <br />and mainlenance of the improvemeni or other righbol-way use herelo <br />applied fnr and lurther agrees to remnve same upon nulice trom the <br />Ciry and to r�lace public property damaged ihereby. <br />WORK AUTHORIZE�� 9V THIS PEFiM1T MUST BE STAFTED WITh11N <br />180 DAYS OF �AT� PEFMIT IS ISSUED AND THEREAFTER IS TO <br />BE �ILIGENTLY PURSUED TO CUMPLETION. THIS PERMIT MAY BE <br />I;ANCELLEO BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />FROJECT OVER 90 DAY : DURATION. <br />