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Date_��' <br />Application For <br />PUI3LIC WORKS PER1II��T <br />Print or Type Oniy <br />Dn � <br />owno� <br />� �;.� ,�, r, - <br />Applicant <br />Describe Propcsed Work <br />Project Address (if known) <br />Mailing Nddress <br />_ 9Y/� <br />f� <br />Zip <br />Zip <br />Attach four (4) copies of plans for pro{�osed work - Draw to scale and note ihe following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existiny and <br />proposed structures on the lot <br />• Existing and proposed nNlities <br />PERMIT CONDITIONS <br />Publit'u Wor�s Permpi�l a/� �� ��fp/� J <br />BIOO.Oc01. u A l%1�I �Illt'Q_ <br />Pu011c Works Fce <br />Tatai Foe S _ <br />Less Appl Fee Paitl S_ ��_ <br />Dalancc Oue $ <br />• Centerline of street <br />• Indicate Nor;n <br />v Show any proposed grading changes <br />• Show measurements <br />THIS <br />Phone <br />Phune <br />t. All calls for inspectir,n shall be made 24 hrs. in advance - phone 259-88 , 3. <br />2. All work shall b- performed in eccordance with this permit and current City of Everett Design and Construclion <br />Standards anC : pecifications. <br />3. Call Locatior !Jnderground Serv'^e 48 hrs. belure you dig. TOLL FREE NUMBER 1-$00-424•5555. <br />4. ANY GRADING DONE ON 'PHIS LOT SHALL BE DONE SO AS NOT TO IMPACT PHE <br />SURROUI4DING LOTS WITH RAINWATER RUNOFF. <br />5, ANY CURB & GUTTER OR SIDEWALK DAMAGED DURING CONSTRUCTION SHALL BE <br />REPLACE� BY THE APPLICANT. <br />t.� H/1�. f7702/�''%�� � � t� � <br />Approv�d for Cc^;truciion Date <br />�--Ci�� �L �t��12 <br />FINAL INSFECTION � Date <br />Approved as Constructed V <br />everett FJBLIC INORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 253-&6' S <br />ACKNO'l/LEDGEMENT OF CON7ITIONS <br />/•, <br />L J <br />The undersigned owner/auplicant hereby agrces to hold and save harm� <br />less ihe City of Everett from any and all claima (or damages, costs, <br />expenses, or causes of action that may arise because ol installation <br />and maintenance of the improvemeN or other righPof-way use hereto <br />aoplied tor and lurther a�rees to remove same upnn nolice irom ihe <br />City and to replace public properry dama�ed ihereby. <br />b�i....�_. �/� � —� , ,i c� � � i�. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MU51� �E STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED ANG TFIEkCAFTER IS TO <br />BE DILIGEtJTLY FURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELL`"D BY THE CITY UFON ANY S70PPAGE OF WORK ON THIS <br />PROJECT OVER 90 UAYS DURATION. <br />