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ete�{�(o <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Oescribe Proposed Work <br />Project Address (i( known) <br />Address <br />MVUICJJ <br />_ r,.!>�• <br />City <br />L�IY Zip <br />Attach lour (4) copies ol plans lor proposed work • Draw to scale and nofe the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions ol all existing anA <br />proposed siruc�ures on the lot <br />• Ezisting and proposed utililies <br />POUimWorhsParm�ity•� `� �/+�—��`% <br />BIEB.DeUt+ O�////�/�) <br />�'___ <br />Puehc works fee —� <br />Totel Fee $ <br />less Rool Fea Paia $ <br />Balanca0ue S �� — <br />S <br />• Centerline of s�reet <br />• Indicate North <br />• Show any proposed gradinp changes <br />• Show measurements <br />PEf7M1T CONDITIONS <br />1. All calls for inspec!ion shall be made 24 hrs. �n advance - phone 259•881 5. <br />2. All work shall be r.erlormed in accordance with ihis permit antl current City of Everett Design and Consiruction <br />Standards and Specificalions. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL F7EE NUMBER 1•$00•414-5555. <br />4. ANY GRADING DONE ON THIS LOT SfiALL BE DONE SO AS NOT 'PO IMPACT THE <br />SURROUNDING LOTS WITH RAINWATER RUNOFF, <br />5. ANY CURB & GUTTER OR SIDEWALK DAMAGED DURING CONSTRUCTION SHALL HE <br />REPLACED -Bi�-THE- APPGiCANT. <br />6. ROOFTOP DOWNSPOUTS SHT,LL BE TIGHT-LINED TO $-Fi�--PUgtr C DRhINAG6 SYSTEM <br />7. A-Sf1II.�REEOR�F@R-THi9-i,-pT-Ig"REQU�Rgp-gEFORE-CONC-RETE_E'D12 THF <br />FOI�N�A'PiON- IS POURED. <br />� / /iL/!��!>-''''��' � / <br />Approved for ConstruGtfon /hate <br />� ` ZZf �z.� 18. <br />FINAL INSPECTION Date <br />Approved as Consl� ucl .� <br />everelt PL'BLIG WORKS DEPARTMENT <br />� 3200 Ced. r Sireet <br />E�erett, Wn b8201 <br />Phone:e59�8815 <br />ACKNOWLEDG[MENi OF CONDITIONS <br />� <br />O <br />The undersigned owner/applicant hereby dgrees to hold and save harm� <br />less Ihe Ciry oi Everetl trom any and all claims lor damages, cosis, <br />expenses, o� causes ol action that may arise because of installation <br />and maintenance of the improvement cr other righFol�way use hereto <br />applied lor and luriher agrees to remove same upon notice hom Ihe <br />City and to repi ce public property damaged thereby. <br />_ � <br />✓/ '��- 3 -� Q6 <br />Signa�ure of Applicant `� ate <br />WORK AUTHORIZEU BY THIS PERMIi MUST BE SIARTE WITHIN <br />180 DAY� OF OATE PERMIT IS ISSUED AND THF�7EAFTER !S TO <br />BE DII.IGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANGL-LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT Ol'F: � 90 DAYS DURATION. <br />