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Date �� � �� � ` �� <br />Application Por <br />pl�BLfC 'WOR�CS F�E�iMIT <br />Print or Type Only <br />; <br />-�'�.��i�– � ^-��,� ,-J l�� —���' <br />Owner Mailin9 Ado�i.. . <br />L� <br />olicant <br />Describe Proposed Work <br />✓ <br />PUUhc Wo�ks Pm��m�j � � /� <br />`-'// 1 "_'.�1.�!-l� <br />Bltlg. �epl. a +� - <br />Pu�ll<WoikSFee 5 <br />.o�s� F�� <br />Less ApPI Fee Pala 5 <br />Ealancc0ue S �� <br />� <br />Zip <br />MailingAdiress CitY Zip Phone <br />Prolect Address (if known) <br />�i 0 � — 9'�x �� 4.�s: �T <br />Altach lour �4) copies of plans for proposed work - Dra+v to scale and note the following as applicable: <br />• Property Lines <br />• Qutline and dimensions of all existing and <br />proposed siruclures on the loi <br />• Exisling and proposeG utilities <br />• Centerline of strcet <br />• Indicate Norlh <br />• Show any proposed grading chanqes <br />• Sl;ow measuremznts <br />TIiI,�i <br />PERMIT CONDITIONS <br />1. All calls for inspection shall �e made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedurmed in accordance wilh this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Lo�aticn Untierground Service 48 hrs. betore you dig. TOLL FHte i: �MBHR 1-800-424•5555. <br />4.ANY CHANGB IN THL� DRIVEWAY CUT MUST BE APPRG�ED <br />BY THE FUBLIC WORKS INSPECTOft. <br />5.CONNECT DOhNSP0UT5 TO PUBLIC DRAINAGE SYSTEM. <br />6.KEEP CITY STREETS CLEAN AT ALL TZMES. <br />7.ANY DAMAGE TO THE CURB AND SIDEWALK WILL BE h�� ".TP.ED <br />TO THE SATISEACTIOh OF THE PUBLIC WORKS PEP".'. <br />� ���.� -�►� <br />P.,proved for Construction //j /� D te <br />�G' � 'k�i% �'�� � �U— <br />' INAL INSPECTION Date <br />Approved as Cunstructed <br />everett PUBLIC WORKS UEPARTMENT <br />� 3200 Cedar Sireet <br />Evnrzll. WA 98201 <br />Plione: 259�8810 <br />_� <br />ACKNOWLEDGEMENT Of CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less lhe City ol Everett from any and z' claims for damages, costs, <br />exp �nses, or r,auses ot acfion ihat may arise because of installation <br />and maintanance ot th:, improveme�t or other ri9ht-of-way use hereto <br />applied for and further 2grees to remove same upon notice from fhe <br />City and to replace public nroperry damaged �hereby. <br />� �—a9-irz <br />Signature of Applicant Date <br />�NOHK AUTHORIZED BY THIS PERt41T M�ST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS iS.`iUED AND iHEREAFTER IS TO <br />BE DILIGFNTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF N'ORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />