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Date��� <br />Applicatioc For <br />P'UBLlC WOl�KS PERMIi <br />Print or Type Only <br />-�,' � �- -`� / <br />Owner <br />� <br />ll �' � <br />Applicam <br />Describe Proposed Wcrk <br />Projec� Address lif known� <br />Address <br />City <br />2ip <br />Pu�I�c Yloixs ParmiL� C '� `��� <br />oia� oeni. s el �% �);�— <br />Puehc Wo�xs Fca <br />Totm Fer S __ <br />Less FOPI. Fee Paid $ <br />Balancu �uc $ _�� <br />Mailing Address City Zip Phone <br />so1� - �rrx ,�v� wEs-r <br />Attach four (4) copies of plans lor proposed work � Draw to sc;le ami note the foilowing as applicable: <br />• Property Lines <br />• Outline and dimensions ol all existiny and <br />proposed struciures on the lot <br />• Existing and proposed utilities <br />O Centerline ol s�reet <br />O Indicate Norih <br />s Show any proposed grading changes <br />• Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in 3dvance � phone 259-8810. <br />2. All work shall be performed in accordance with his perm't and cnrrent City ol Everett Design and Construotion <br />Sta.ndards and Specifications. <br />3. Call Location Underground Service 48 hrs. bei.� ,,•cu dig TOLL FREE NUMBER 1-800•424•5555. <br />5 <br />6 <br />7 <br />ApProved 'or <br />ANY CHANGG IN THE DRIVEWAY CUT MUST BF. AFPROVED <br />BY THG POBLIC WOl?K� INSFECTOR. <br />CONNECT DOWNSPOUTS TU PUBLIC DRAINAGE SYSTGM. <br />KEEP CITY STREETt9 CLEAN AT AI�L T.LMES. <br />ANY DAMP.GE 'I'0 THE CURB AND SIDE�IALK WILL <br />TO THG SATISFACTION UF THE PUBLIC WORKS <br />FINAL INSPECTION <br />Approved as Consiructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Evereit, WA 98201 <br />Phone:259-8810 <br />���D te <br />/G._/�-%U <br />Date <br />Bfi REPAIRGD <br />DGPY. <br />ACI:NOWLEDGEMEfJT CF CONDITION3 <br />The undersinned owoer/applicanl hereby agrees �o hold aiid save harm� <br />less the City of Everetl irom any and all claims for damages. cosis, <br />expenses, or causes of action �hat may arise because of installation <br />and maintenar.ce of the improvement or other righPof-way use hereto <br />applied for antl further agrees �o remove same upun notice Irom the <br />Ciry nrj to replac� ubhc property maged �hereby. <br />,�e��,� ��-/lG�; '�'� �l"Il� ``l� <br />Siy ture I Applica-������ Date <br />WOqK PUTIIORIZE� BY THIS PERM;T MI'�' BE STARTED WITHIN <br />180 DhYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT h1AY BG <br />CANCELLED �Y THE CITY UPON ANY STOPPAGE OF WOFiK ON THIS <br />PROIECT UVGR 90 Dl.YS DURAiION. <br />