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�. ��� <br /> Date�/�`��l� Pu�lit Works P rmi�t _L�'6—A2 <br /> App�ication For eioa oeo�.+ L,i��.� �.� _ <br /> PUBLIC VI/ORKS PERMIT PuDlicWorksFea � <br /> .a���Faa s <br /> �ess npo�Fae ra�d S� _ <br /> Print orT}•pe Only Balance�ue 524� — <br /> �' �,��,� ���� G _U ` �R �c0.ti,,.�,da- R�o a� �� 2( �F /�. <br /> Owner MaiN Address City Zip Phone <br /> �l.Q,t�'`.'eJ — . <br /> Appl cant Mailing Address Ciry Zip Phone <br /> _ `-1�� � � �' � <br /> Descr'be roposed Wark � cYU � _, <br /> �� <br /> � �roject Address�if known) _�n��e�— 5 t��qG�F .S E, ___ � <br /> A;tach lour(4)copiec o1 plans for proposed work- Draw to scale and note the following 2s applicable: � � <br /> • Property Lines • Centerline of s'reet //� <br /> • Outline and dimen:�ions of all existing and • Indicate Norih V� <br /> �� proposed structures on the lut ! Show any pro�+osed grad���g changes <br /> • Existing and proposed utilities • Show measurements � <br /> --_�—■ DO IJOT WRITE BELOW THIS LINE ' � I' <br /> PERMiT CONDITIOIJS <br /> 1. Ail calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and C�mstruction <br /> Sta,�darda and Specifications. <br /> 3. Call Location Ur.derground Service 48 hrs. bebre you dig.TOLL FREE NUMBER 1•800•424.�u-,55. � <br /> 4. AN+' GRADING UONE ON THIS LOT SHALL BE DONE SO AS ldOT TO IMPAt�T THE O <br /> SURROUNDING LOTS WITH RAINWATER RUNOFF, <br /> 5. DOWNSPOUTS FF;OM THE BOILDING ARE TO BE TIGHT—LINf�D TO THE PUBLT_C <br /> DRAINAGE SYSTE�?. � <br /> 6, ANY CLRB & GUTTER OR SIDFWALK DAI9AGED DURING CONSTRUCTION ';HALL BG <br /> REPLACED BY `1'HE APPLICANT. � <br /> 0 <br /> a <br /> ACKNOWLEDGcMENT OF CONDI"710NS <br /> Thc�undersigned owner/applicant hereby agrees tr�hold and save harm• <br /> �— less the City of Everett from any and all claims tor damages, cwts, <br /> expenses, or czuses of action that may arise becaus2 of installation <br /> �i� ���� �J/�� and ma,�itenance of the improvement or ott.er riyhl-of-way u;e hereto <br /> applied lor and lurther ayrees to remove same upon notice from ihe <br /> Approved lor Consiruction Date �nd to replare ouhlic property damaged thereby. <br /> �'Z3 ��� c-{��/C�I 3_�a� c� <br /> FINAL INSPl: ION Date �—�`__!"� _ a �• <br /> Approved as Constructed Signatwe ot Applicant Date <br /> WORf�, :;UTHORIZED BY THIS PERMIT MUST BE STkqTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DF'fS OF C�ATE PEflI,11T IS ISSUED AND TFIEREAFTER IS TO <br /> � 3200 Cedar Sireet BE D!LIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 96207 CANCELLED OY THE CIT`/UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJEC:T OVER 90 DA':c ^URATION. <br /> � <br />