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Date � ���4f) <br />� � <br />� Applicalion For <br />pl�'�3L�C iNORKS PER�lIIT' <br />Print or'�ype Orily <br />S��r� /���,�s,�,� /�Ly <br />Owner L', <br />_ S�� <br />ApPlicant v= � ; Address <br />Zin <br />Ciry ��p <br />Pobhc Wi rMs PermC a <br />'�='/C� c� � � <br />6109. DrPi.,. __�iO .! % _ <br />Pub:�:_W�rlu Fee <br />iv�,i.:�� $. <br />LCv Appl FeC Palrl S_ <br />Balance Oue $ �� <br />Phone <br />n ��!! <br />Describe P�uposed Work NPr� .r�.,nf� �H/�i� /�PJ��CILl�.L¢,..._��N�q/ii�y� <br />Project Address (if known) <br />,c <br />/�V� <br />Attach lour (4) copies of �lans for proposed work � Oraw to scale and note the following as apP�icable�. <br />• Property Lii ; <br />• Outlme and o�r,�ensions o! all exis�ing and <br />Uro�osed struc�ures on fhe lot <br />• Existing end proposed utilities <br />NOT WRITE BE <br />• Centerline o� ^treet <br />• Indicate North <br />e Show any proposed y.�ding changes <br />• Show mc-asurements <br />PERh11T CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in accordance with ihis permit and current City of Everert Design and Gonslruction <br />Standards and Specifications. <br />3. Call Location Cnderc�round Service 48 hrs. belore you dic3. TOLL FREE NUMBER 1-800•424-5555. <br />4.ANY Cf[ANGE IN THG DRIVGWA`I CUT MUST BG APPROVGD <br />BY 7'HL+ FU9LIC WORRS INSPFCI'OR. <br />5.CONNGCT DOWySPQUTS TO T�c"o--C�i$-$f2-AINS. 1�:.�3�.�C. 02A.ic�tAE��-. �Y�i�M, <br />6.KEGF CTTY STRE�TS CLGAN AT ALL TIMSS. <br />7.ANY DAMAGE TO THE CURB AND SIL'EIJALK UIILL BE REPAIRED <br />TO THF_ SATISF(1CTZON OF THE PUBLIC WORY,S OEPT. <br />FINANNSPECTION <br />Approved as Constructed <br />evrrett PU3LIC WORKS DEPARTMENT <br />� 3200 Cedar Sireel <br />Everett, WA 98201 <br />Phone:259-6�10 <br />7 ' C� <br />' Dale <br />ACKfJOWL[DGEMENT OF CONDITIONS <br />� <br />�J <br />� <br />�; <br />Thc� undersiyned ownedapplicant hereby ayrees to hold and save harm- <br />less the City ol Everett Irom any and all daims for damages, costs. <br />ezpEnses. or causes ol action that may arise Uecause o( installation <br />and mainlenance of the improvement o� oPier right-of-way use herelo <br />appGed for and fu�iher ac�rees to remove same upon notice from tiie <br />City and to replace public p�operty damaged Ihereby. <br />�!��-(�- '3'/9 - ya <br />SignaWre of Ap{ icant Date <br />WORK /IUTHORIZED f3Y THIS PERMIT M;iST BE STARTED WITHIN <br />�BO DAYS OF DATE PERMIT IS ISSUED AM THEREAFTER IS TO <br />BE DILIGENTLY PURSUED T.) COMFLETION. THIS PcRMIT MAV HE <br />CANCELLED BY THE CIiY UI'JN ANY STOPPAGE OF WORK, ON THIS <br />PROJECT OVEA 90 GAYS DURATION. <br />