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Gate �-.=d'� <br />Applicat�on For <br />PU�LIaC G'VOF�KS PERIUfiT <br />Print or Type Only <br />/�'l � <%9E� /v <br />oW��� <br />[;.eo.t/�•�✓ C� <br />Applicant <br />Sr <br />! ; _ <br />Prphc Works Parmit + `� � � `� � <br />BIt1y.00Dt � <br />Pvul¢ Worns Fee <br />To1:11 FeC $ <br />Less Apol. Fcc Paie $ <br />Bnlance ouc S G � �� <br />Ci�y Zip <br />Ea��.��C-'n-M!'iG �,,.'qJ/' <br />-FF .T <br />Ci�y 2ip <br />Describe Proposed Work C�ti�=�r.E'G GT /•� Siy��� ,c� Ff��oit</ /�'�.no,r <br />Project Addres� (il known) c�'9n9— i�� AdE� S. E_ <br />Atlach four (4) copies of plans for proposed wcrk - Draw to scale and ncte the foilowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed ;tructures on Ihe lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />• C^n�w!;ne of street <br />i Inc�:,;r North <br />O Show :ny proposed grad�ng chan.-,�:s <br />O Sh!�w measurements <br />Phane <br />...� - C :iC' ^ <br />Phpre _'— <br />I. All calls for inspec�inn shall be made 24 hrs. in advance � phone 259•$81 5. <br />2. All work shall be performed in accordance with Ihis permit and current City oi Everett Deslgn and Constructiun <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBF.R 1•800•424•5555. <br />4. ANY GRADING DONE ON THIS LOT SHALL BE DONS SO AS NO1' TO IMPACT THE <br />SURROI�NDING LOTS WSTH RAINWATER RUNOFF. <br />5, ANY CURB & GOTTER OR SIDEWALK DAMAGED DURING CONSTRUCTION SHALL BE <br />REPLACED BY THE APPLICANT, <br />�i. %' : � !r, �// /cly� <br />�.'-/G-' /���C-Y�i � r <br />Apprnved for C nstruction Dale <br />� 1 2 �1 <br />FINAL INS ECT O�' Uate <br />Approved as Constru:�ed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Csdar Stre=t <br />EveretC WA 98201 <br />Phone:259-8815 <br />�CKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />_ / <br />� <br />� <br />� <br />a <br />Tha undersigned ownedapp�icaN herebv agrees to hold and s�ve harm� <br />less the City ol Everett from any and all claims Iw dama9es, costs, <br />ezpenses, oi causes of action Ihat i iay arise tacaus�� of insta:lation <br />and maintenance ol lhe improvement or other right-cl�way �ise hereto <br />applied for and furiher agrees to remove same upon not� .e from Ure <br />City and to replar,� public property damaged thereby. <br />, �� � 3�z�-�� <br />igna�u'S re of App�l�ca �� � Date <br />WORK AUTHORiZ 0 BY 1'HIS P[RMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CAIJCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />