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�, <br />Date `3/z7/�I <br />� pplication For <br />PUBLi� WORKS PERMIT <br />Print or Type Only <br />Go I � Cor 1031 <br />Owner M <br />�\\/IV ` <br />Applicant M, <br />Describe ProposeC Work _ � SF <br />T� p��r�N� _3��� � <br />Zip <br />P�o�ectAtldress�itknown) St�7. ��CTMn�� A�� <br />Attach lour (4) copies of plans for proposeA work - Draw to sca�e and note the following as apulicable: <br />• P�operty Lines <br />• Outline end dimensions of all ezisting and <br />proposed structures on ihe lot <br />• Existing and proposed utilities <br />PubLc Warks Parmit x' � �� � <br />B�4C Dept � � � <br />PuOLp Works Fea — <br />Total Fea s —� <br />LessAopl.faePelf S—. <br />BalanteDue f ZQ <br />'_Ol 2 Sz- Z� <br />� Phone <br />• Cen' �rline ol street <br />• InAicate North <br />• Show any proposed gradinr changes <br />• Show measurements <br />PERMIT CONDITIONS <br />7• All calla lor inspection shell be made 24 hrs. in advance - phone 259-881p, <br />2. All work shell ba peAormed in �ccordence with this pe�mit and current City ot Everett Design antl Construction <br />Stendards and Specifications. <br />3. Call locatlon Underground Service 48 hrs. before you dig. TOLL FREE NUMBER �-BQ�.424•5555. <br />4- PAVA FROM THE Gfn;E OF PqVEMENT IN THE RIGHT OF 4�AY TO <br />GARtiC,R DOORS W7TH FORTLAND CEMF..NT CONCRF.TE. <br />5- INST3Li, SII.9' FENCE AS PER STD PLAN #205 AI,ONG T;{g NORTH <br />PROpF.RTY LINE PRIOR 'LO F..XCAVATION. <br />�. DIRF.CT AI,L ROOF TOP DRAINAGF TO A DFY WELL CAPABLE OF <br />INFILTRATiNG RUNOFF AT A RqT_r,, THA7' WILL NOT IMPAI'T <br />ADJOlN7NG PROpERTI$S � <br />KRFP ;,�PRRETS CI�RAN AT ALL TIMER <br />ACKNOWLEDGEMENT OF CONDITIONS <br />I C — <br />�-�! � <br />/ <br />Approve or Construc ' n / Da e <br />� �_r� ,3 /�-%2_ <br />FINAL INSPECTI�.�t! Date <br />Approved as Cor �r�i� ed <br />F'�9LIC WORKS DEPARTMENT <br />3. 'A Cetlar Street <br />Everet4 Plq gB201 <br />Photie: 255-8810 <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save ha�m� <br />less Ihe Cily of Everett Iron. any and all claims br damages, coste, <br />expenses, or causes of action that may arise because of installalio i <br />and maintenance ol the improvemenl or olher righbol•way use hereta <br />applied lor and lurther agrees to rvmove same upon notice trom th � <br />Ciry and to repla public property damagetl Ihereby. <br />Signature ol App icant Date <br />WORK AUTHORIZED BY THIS PERMIT NUST BE STARTED WITHIN <br />180 DA'iS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILfGENTLY PURSUED TO COMPLETION. THIS PERMIT M17AY BE <br />CANC[ILED BY THE CITY UPON A�Y STOPPAGE OF WORK ON THIS <br />PFOJr'Ci UVER 90 DAYS DURATION. <br />