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Date__��`%� <br />Application For <br />PIJBLIC W(7RKS P��MIT <br />Print or Type Only <br />i <br />� -i������� �`7 ��' ,�Jl� ��i � <br />Owner Maihng Aadress City <br />�� �l <br />Applicant <br />Describe Proposed •Nork <br />/ ✓" <br />Pu01"o \VOrhs Vu.unl� n �' "' � <br />� ) - ) .-;.y . _ — <br />Bltlp pePl a - <br />Pu�L� \Yprks Fec <br />imnl Fee � <br />Less AppL Fee PaiJ S <br />6nlnncc Duc $ ��� <br />Zip <br />Mailing Address Cilv Zip Phone <br />Project Address (if known� <br />� oz� - <br />Adach four i copies of plans lor proposed work - Draw to scale .�od note the following as applirable: <br />'� <br />• Property Lines <br />s Outline and dimensions of all eeisiiny and <br />proposed etructures nu ;he lot <br />• Existing and propo;:ec ntiii�ies <br />• Centerline af street <br />i Ir.dica�e NorPi <br />�1 Show any prpposed 9rading chanycs <br />�+ St�ow measurements <br />THIS <br />PERMIT CONDITION� <br />1. All calls for inspection shall be made 24 hrs. in advance- phon� �59•8811� <br />2. All work shall be performed in accordance with this permit and current Ci!y o: Everett Design and Construclion <br />Standards and Specifications. <br />�. Call Location Underground Service 48 hrs. before you diy. TOLL FREE NUM1.3ER 1•800•424-5555. <br />ANY CHANGG IN THE DRIVF�AY CUT MUST BE APPRUVED <br />BY THIi PUBLIC WORKS INSL!;CTOR. <br />CONNECT DOWNSPOUTS TO PUALIC DRAINAGE SYSTEM. <br />KF.EF CITY STREGTS CL6AN AT ALL TIMES. <br />ANY DAMAGE TO THE CURB ALdD SIDEWt1Lic V�ILL BS R�PAIRI:D <br />Tr THL� SATISE��JTION OE THG PUBLTC wORKS DEPT. <br />.��' ��� � � i9U <br />Approved (or Cons�ruct� Date <br />,�t/ <br />�✓C, �G�'= �'� _� �_ ��7- i'a <br />FINAL INS�[CTION Date <br />Approved as Consiructed <br />everel[ PUBLICI^/OFlKSDEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone�259-8�10 <br />ACKNOWL[DG[^AEfJT OF CONDITIONS <br />Tha undersiqneu o�.vnedapplicant hereby agrees �o ho!d and 5ave harm- <br />less ihe City of Everett (rom any and all claims foi damages. cosls. <br />expenses, or causes of action lhat may arise becau,a n( inslallation <br />and maintenance ol the improvement or o�her righPorc�:��y use hereto <br />applied fo� and funher agrees to remove same upon r;o6ce trom the <br />City and to replace public property damaged iherebv. <br />3-��-� <br />Signature ol Flpp icant Date <br />WnRK AUTHORIZED BY THIS PERMIT MUST BE STARTED W THIN <br />ibi) DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE D�LIGF�TLY PURSUED TO COWPLETION. THIS PERMIT h1.�Y 3L <br />CANCELLED BY THE CITY UFON ANY STOPPAGE OF �'JORI( C:�J �hIG <br />PROJECT GVER u0 DAYS DURATION. <br />