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Date��f <br />ApPlicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />M211If1(J AtltllQ55 <br />Describe Proposed Work <br />Project Address �il known) <br />c�iy <br />Cil�y <br />Pu�Irc WorFn �crmit � {,�3�� <br />BiE9 Uopi � �(� <br />PunM1c works Fee <br />Total Fee S _ <br />Less Aoo� Fea Pp�C S� <br />eaie��e o„� s 20 � <br />Atlach four (4) copies of plans for proposed work • Draw to scale and note ihe followi.ig as applicable: <br />• Properry Lines • Centeriine of strcet <br />• Outline and dimensions ol all existing and • Indicate North <br />proposed structures on ihe lol • Show any proposed c�rading changes <br />• Eaisting and proFosed utilities • Show measurements <br />Q . <br />DO �. <br />PERMIT CONDITIONS <br />LUP <br />Phone <br />Phone <br />1. All calis lor inspection shall be made 24 hrs. in advance - phone �59•881 5 <br />2. AII work shall be performed in accordance with ihis permit and curren� Cdy of Everett Design and Construction <br />Slandards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />4. ANY GRADING DONE ON THIS LOT SHALL BE DONE 50 AS tdOT TO IMPACT THE <br />SURROUNDING LOTS WITH RAINWATER RUNOFF. <br />5. ANY CURB & GUTTER OR SIDEWALK DAMAGEU DURING CONSTRUCTION SHALL BE <br />REPLACED BY THE APPf.T('ANT <br />6. ROOF—i0P DOWNSPOUTS ARE TO BE TIGHT—LZNED 'CO A DRYWELL <br />�y/ 7 <br />� .�G�W'r �� L _� r ,L^ <br />Approved lor ons�ruction Date <br />l:v.l irva� 1 „ , �.�Z���,�7 <br />FINAL INSPECTION � Date <br />ApProved as Conslructed �- <br />evrmn PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett WA 98201 <br />Phone 259�8815 <br />ACKNOWLEDGEMENT UF CONDITIONS <br />7' <br />� <br />� <br />� <br />� <br />O <br />a <br />The undr,,signed owner/applicant hercuy agrees to hold and save harm- <br />less t4e City of Everett Irom any and all c!3ims lor damnges. cosis. <br />expenses, or causes ol ad�on Ihai may arise bec�use o� mstallatinn <br />and mainienanre ol the imp�ovemen: or olher righbof�way use hereto <br />applied loi nrd furtht �rees lo remove same uGon notice Irom ihe <br />City and to repl ce puL��., pro rty damaged thereby. <br />g alure of App i t DaY . <br />WORK AUTHOFIZcD BY THIS PERMIT MUST BE STARTCD WI1h.IN <br />180 DAYS OF DATE PERMIT IS ISSUEL` AND THEREAFT[R IS !O <br />F.E DILIGENTLV PGASUED TO COMPLETION. THIS PERMR MAY BE <br />CANCELLED BY THE CITY UPGN ANY STOFPAGE Of WO�K ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />