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Date�3��1`�' <br />r <br />, � Application For <br />PUBLIC WORKS <br />Print or Type Only <br />Appiicant <br />Describe Proposed Work <br />` TO POSTInG _ <br />RERMIT <br />fJ <br />O <br />0 0 [� r_� r,�� �ci <br />q_ r_-i,--�c,c �n � <br />� r; ;, �n o r� . ^� <br />0 o r:i �:? -�r ��;,� C.: <br />,�:'.I � Ili �11 U'. <br />� �� � <br />�5�` �. � Q�'Y� <br />m o tr� r� �r rn 'r� _ <br />���i u o,-n i_; r_, p i.. . <br />�. o _i ..i i�.�. � r.�: [. <br />_� x: rir ri_ �:: r;.� rr: r� <br />Mailing Address <br />Project Address �if known� G`i" I`[� � <br />i'� �.�i C7 ;- <br />�, �., ��� ,;: <br />u� O r �� fr <br />O C� tf� .� <br />.-, r, ._, �_ <br />,. „ ,.. <br />,c �J�,' � <br />G� <br />fi C'.I 'r ii?� <br />��i o iii n i.: <br />�-r rr.'-.'� i� i cn p. <br />_:t sc m �n 7� � <br />Zip <br />Pu01ic Work4 Permit s �"{ �`� �7+' / <br />BICg. DeO�. � _ �y/ � � C� <br />PuCbt Works Fee <br />Total Fae S <br />less AOPI. Fee Ymtl $ <br />i <br />Balance Due S — <br />Phone <br />t�l e"r khau 5v. L <br />Atlach four (4) copies of plans for proposed work • Uraw to scale and note tne tollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be maAe 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this oermit and curr�ant City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />4. L�stal! rock constnic�on enVance bzhmd �iveway as per ciN standard 1f2U8 and erosion control as direc[ed t <br />FubGt W'orlt.; L��pectur. <br />S. Keep ciry sVeets clenn at all tunes. <br />ti. Gurb gurter a�id sidewall: in die pla[ a�•e new e��d widuniaged, arry damaee d�ereto shall be replaced a[ the <br />tiscrefion uf tl�c FubGc w'orks H�spector. <br />� Arry chenge in the drivew:ry cut must be approved b}� the P1A� inspector, width at prop line limited to exisdng <br />apruu widW. <br />8. Adjust watcr boxes to p'adc at cnd of constntcfion. <br />9. llrivewaVs shall be cmnpleteh! cmed beCore d�ivine on thein. <br />10. RuoRup cL�u�aka s6a11 Ua ili�ehu�e�: <br />. to the sitr's stortn drain svstem (private or pubii:l <br />. to a resiJenaal rooi downspout system desi��ed per �ection •i-9.4 oF ti�e ciry s[a��dards <br />onto splash blocks <br />'Phe method selected will be subject to Pnbfic <br />W <br />F- <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />Wn�� The Gndersngn dbWrer%a p�ic nnt herebyag ees�tol oNd and save harm- <br />— less the Cily ol Everett from any and all claim; for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />�n inA L �/'� � I/' �/�d and maintenance ot the improvement or other right-of•way use hereto <br />X.—F�1 �C� �C applied for and further agrees to remove same upon notice f�om the <br />Approved f�C�nstructio� n _ �� Date ' and to replace public properry damaged thereby. <br />� <br />Approved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />Date <br />GVwv� /�� c� //- zK- <br />Signature ot Applicant Uate <br />WORK AUTHORIZED BY THIS PEP.MIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AMD THEREAFTER �S TO <br />BE DILIGENTLY PUflSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOHK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />