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Date �� ���� �J� � <br />Applica�ion For <br />RUBLIC WORKS PERlVIIT <br />Print or Type Only <br />� <br />� <br />Mailinc� Address <br />���Y <br />(/ <br />PUCIic 1Yorks Permi� q � � � . <br />ela9. oent e ��. . . J �. _;�J��l <br />v����� We,ks: �� S <br />Tolal Fcc <br />Less AOPI Fec Pa� � _---.— <br />Balance Oue $ ��� <br />Phone <br />Aoolicant Mailing Address City Zip Phone <br />i �"' � <br />_2��--� � <br />.;:';' 7 .� %�I�-� <br />Prolect Address lil known) <br />Attach lour (4) copies of plans for proposec' <br />• Propr;rty Lines <br />i Ouf�ine and dimensions ot all e <br />pror.osed structures on ihe lot <br />• Exis:ing and proposed t �ililies <br />� <br />ork - Draw to scale and note ihe following as applicable: <br />nq and <br />„�� : w <br />DO <br />• Centerline of sireel <br />• Indic::te NOAh <br />• Show any proposed grading changes <br />• Show measuremenls <br />PERMIT CONDITIOPJS <br />t. All calls for insneciion shall be made 24 hrs. in advance - phore 259•8810. <br />2. All work shall be pedormed in acwrdance with ihis permit and curreN Giry ot c. ^rett Design and Censtruction <br />Standar,s and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•SG�-424-5555. <br />ANY CfIANGfi IN THE liRIVEWAY CUT MUST BE APPROVED <br />BY THS FUBLIC WORK_S INSPECTOR. <br />CONNGCT rOWN5P0UTS TO PUBLIC DRAINAGE' SYSTEM. <br />KEEP G�.'Y STREETS CLEAI� AT ALL TIMES. <br />ANY DAMAGE TO THE t;URB AND SIDEWALK WILL BG RE:PAIRED <br />TO THG SATISFACTION OF THE PUBLIC WORKS DLPT. <br />__ <br />��Q,IA�.�_ �'`�! C.I�U:._ L r i..�. l'i_ <br />_r _ �.�_ <br />Approv2dforConst� tion Date <br />��% / � <br />.'C-l�' ' /�" //-�G <br />FINAL IfvSPEGTION Date <br />Approved as C.�nslructed <br />everett PUBLIC WO�1KS DEPAFlTMENT <br />� 3200 Cedar Street <br />Everetl. WA 98201 <br />Phcne:259�8870 <br />ACfWO�YLEDGEMENT OF COPI� i IONS <br />W <br />� <br />M / <br />� <br />�' <br />� <br />V� <br />�qu/ <br />L�i <br />-�ne unders��ned ��+�ner/applic�n� hereby a9rees �o hold and save hann- <br />r.sr. the City oi ��retl (rem any and all claims for damages, cos�s. <br />�x-. �.�nsec or ce:�r: �:^ ^! acfior� that may arise because of installation <br />,-n:� m2��tenance o` ihe improvement or oiher righ�-ohway use hereto <br />aUP��ed for and further agrees �o remove same upon n ice irom the <br />City � nd lo replace public property damaged Ihe e y. <br />��� � <br />. �Z3��� <br />Si9na ure ol Applicant Date <br />WORK AUTHORIZGD Bl' THIS PERMIT MUST 8E STARTEU WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY FURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK Onl THiS <br />PROJECT OVEfi 90 DAYS DURFTION. <br />