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te_, �_L��' G <br />Application For <br />PUBLIC WORKS PERNiIT <br />Print or Type Only <br />// 1�'�f � Ca n j <br />owner <br />Sa n1 �. <br />App�icant <br />Describe Prapased Work <br />e=s <br />Mailing Address <br />Prolect Address (il known) /� �is - y°'`=��. s,� _ <br />Zip <br />��P <br />Pu�bc Works Peimn • �"-' —/�� <br />plEp. Dept � ��y�� <br />Pu01ic Wo•b Fee <br />Toini Fee s <br />Leaa Apo� Fea Peitl s <br />��_ <br />Belence Cue S � � O� <br />Altach lour (4) coVies ol p'ans lor proposed work - Oraw to scnie and note ihe lollowing as applicable: <br />• Property Llnes • Cenlerline ol sireet <br />w OuUine �id dimensions ol all existing and • Indicate North <br />proposed structures m� the lol • Show any proposed gradin� changes <br />• Existin7 and proposeC utilities • Show measuremenle <br />PERMIT CONDITIONS <br />Phone <br />Phane <br />1. All calls for inspection shall ba made 24 hrs. in advance - phone 259-8815. <br />2. All work shall ,�,e performed ir accordance with ihis permit and current City cl Everett Design and Constructlon <br />Standards snd Specificat ons. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424-5555. <br />�i ANY GRADING DONE ON TIiIS LOT Si3ALL BE DONE SO AS NOT TO IP9PACT THE <br />SURROUNDING LATS WITH RAIN4iATER RUNOFF. <br />5. ANY CURB & GUTTER OR SIDEWALK DAMAGED DURTNG CONSrRUCTION S[jALL BE <br />REPLACED BY THE APPLICANT, <br />6. ROOFTOP DOW�g.7g��POUTS SHALL <br />.+ /i�Gl...p(% Y-pv.t�nf�.+n <br />7. 1f0&-T FOR THSS <br />FOUNDATION IS POURED. <br />L�y LdEL L <br />BE TIGHT-LINED TO B8L'i�-D[tAiNAGE-9YSTeM <br />LOT IS REQUIRED BEFORE CONCRETE FOR THE <br />`�f��'o�: . 3/�8'�0 <br />Approved for Construc on Date <br />�"„ �1 ,�'lY�nnl.-<:. Z'� i.��� �% <br />FINAL INSPECTION Date <br />Approved as Construcled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt, WA 98201 <br />Phane: 259-8815 <br />AGKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />The undersigned ownedapplicant hereby agrees tc hold and save harm- <br />less the Citq ol Evere!1 Irom any and all cl:ims br damages, cosls. <br />erpenses, or causes ol action that may ailse because ol installation <br />and main�enance ol ihe improvement or other riqht�of-way use herelo <br />applied for and lurther agrees to remove same upon notice Irom �h� <br />City antl to replace public property damaged thereb i. <br />Signature ol Appl� t �� —� a� �� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED INITHIN <br />180 DAYS OF OATE PERMIT IS �SSU[D AND THERE�FTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY 8[ <br />CANCELLED BY THE GTY UPON ANY STOPPAGE OF WURK ON THIS <br />PROJECT OVER 90 DAVS DUR4TION. <br />