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Date�g� <br />Applicalion For <br />PUBLiC WORKS PERMIT <br />Print or Type Only <br />manmg <br />Describe Proposed Worlc <br />Proiect Address (il known) <br />r„oecNo�,F.pe�mn+ �lp^��/ <br />BiaO Dect . ,�(n ����q <br />Puebc worxa Fea <br />'olal Fea S <br />Lese Fpo� iea PeIE S <br />esie��oo�a S <br />Ci�y <br />�%��Y Zip Phone <br />Attach four (4) copies ol plans lor proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines • Centerline of st�eet <br />w Outline and dimensions of all ezisting and • Indicate Norlh <br />proposed sinulures on Ihe lot • Show any proposed grading changes <br />• Existing and ��roposed utilities • Show measuremenls <br />PEqMIT CONDI�fIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - uhone 259-881 5. <br />2. All work shall be pertomied in acc�rtlance wifh ihis permil and current City ol Everetl Design and Construction <br />Standartls and Specilicationw <br />3. Call Location Underground Service 48 hrs. 6elore you dia. TOLI FREE NUMBER 1-800•424•5555. <br />4. ANY GRADING DONE ON THIS IAT SHALL BE DONE SO AS NOT TO IMPACT THE <br />SURROUNDING LOTS WITH RAINWATER RUNOFF, <br />5. ANY CURB & GUTTER OR SIDE�QALK DA[4AGED DURING COIVSTRUCTION SHALL BE <br />REPLACED BY THE APPLICANT. <br />�'J .� Oci <br />� _ <br />> D.eycc/EGL <br />6. ROOFTOP DOWNSPOUTS SHALL BE TIGHT-LINED TO 4`!iE—AHgi,�L�-DRAZtiA�i�gySTEM. <br />7. �.. tvun.Cnh•n <br />n�-R�POR2` FOR THIS LOT IS REQUIRED AEFORE CONCRETE EOR T;3E <br />FOUNDATION IS POURED. <br />� <br />for <br />FINAL INSPECTION <br />Approvaa as Constructed <br />evere'l PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, lVA 9ffi01 <br />Phone:^59�8815 <br />Pate <br />� <br />O <br />ACKNOWLEDI�EMENT OF CONDITIONS <br />The undersigned owner/applica�it he�eby agrees to hold and save harm- <br />less the City ol Everett Irom any and all claims lor damages, cosis. <br />expenses, or causes ol action ihat may arise because ot installation <br />and mainlenance of Ihe impmvement or other right-ol�way use he�elo <br />applied for and furiher agrees lo remove same upon notice Irom Ihe <br />City and to replace public property damaged thereby. <br />„ % / <br />�C/� ��% % � g6 <br />Si nature of Applicant ate ' <br />WORK AUTHORIZED BY THIS PEFMI"i MUST BE STARTE WITHIN <br />1P0 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br />BE DILIGENTLY PURSU[D TO COMPLETION. i HIS PEFMIT MAY BE <br />CANGELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO,;�CT OVER 90 DAVS DURATION. <br />