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<br />Application For
<br />PUBLIC WORKS FERMIT
<br />PU9U0 WORKS DEPP.RTMENT
<br />3200 Cedar Street
<br />Everett, WA 98201 259-8810
<br />uace 1-2z-97
<br />PubIlcN,orksPermitk _�� �
<br />Building Permit N 54031
<br />TYPEURPRINTONLY �i �n f'Q�TING �- publicWorksFee$ ��
<br />Kny/James I:ettesc,n 1�41P- �,rJC;i ,_ . ..:. 2fi:Li �r ".l_ -.,r,1 ��I'ril:_ �16-C�3n1
<br />O�.vner Mailing Address City Zip Phone
<br />own�r
<br />Applicant MailingAdd:ess City Zip Phone ��
<br />Describe Proposed Work
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<br />PROJECT ADDRESS (if known)
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<br />Attach four (4) copies of plans for proposed work - Draw to scale and note ihe following if ap?licable:
<br />°Property Lines •Outline and dimensions ot all existina ard pmposed simcWres on ihe lot •Existing and proposed utilities
<br />•Centerline of sireet •Indicate NoAh •Show any proposed grading changes •Show measurements
<br />DO NC�T WRITE BELOW THIS LINE
<br />PERMIT CONDITIONS:
<br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810.
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<br />2. AII work shall be performed in accordance with this permit and current City of Everel;'Desigi{'and-' �'"""'
<br />Constructicn Standards and Specifications. �
<br />3. Call Location Undei�round Service 48 nrs. before you dig. TOLL FREE NUMBEW�a`$0'0-42�'-5555.
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<br />I F_�:cp cih' >tiects elc�r: _ i.. yS�F^„ J'+_.. t
<br />� Curb �d[er and side�, ��;c u� �i: ,;' �� .�. , , �at�:+ iflhiT'dU'bha11'.�:@e}7ai .. , ,.
<br />discrction of Uic Pubt�, :i �:,�- ;,, ,�. , i�.� H00�09�?E
<br />ti. Am clr,uie.e in the d�i, ,, a+ snu>t l-� ;,a,p�• , ,r, wi'�flTFi%prop$i:W�Ai;9i :i �.
<br />existii�g ;fpron widU�. �OOOz0986
<br />?. Adjust watcrboxes t�� �y:�d�' v� �R�! :•1 �.;�rr.i��� 'r,.�. SE:��cF 57_�-'�t�
<br />8. Drive�vuys shall be compictriy cin;:ci oetorc 6rn�ne on �hem. S!'SDEV 9124b.C�
<br />9. RooRop drtina�,e �hall be �ischarged to tl�e storni cL�tiriagt sh�h loc�ted at ! F�Q� ^,�p��`�D
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<br />Hpprovea ror wnsuucuui� i, �a�e
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<br />�, /� ��.x- 7-a3 ��
<br />FINAL INSPECTION Date
<br />Approved as Constructed
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<br />ACKNOWLEDGEMEtJT OF CONDITIONS
<br />The �.indersigned ownedapplir.ant here6y agrees to hold and save harmless
<br />the City of Everefl from any and all claims for damages, costs, expenses, or
<br />causes of action lhat may arise because of installation and maintenance of
<br />the improvement or other righl-�f-way use hereto applied for and further agrees
<br />to remove same on notice from the City and to replace puhlic pmperty
<br />damaged ther�
<br />WORK AUTHORIZED B�' THIS P�<FiMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMI'iIS ISSUED AND ;�1EREAFfER IS TO BE DILIGENTLY PURSUED TO
<br />COMPLEfIOIJ. ?NIS PERMIT MAY BE CANCELLED BY THE CIIY UPON ANY STOPPAGE OF WOFK ON THIS PROJECT OVER 90 DAYS DURATION.
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