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Date � y Q(� <br />Appiication For <br />PUBLIC WORKS PERMI� <br />Print or Type Only <br />icant <br />Describe Proposed Work <br />Mailinc� Address <br />C�-�� .i <br />Pu�Lc works Permit `-^� �P � <br />pltl0-OCpI v <br />rn — .37�',� <br />aunn., wo,ks voe <br />To�nl Fec S <br />L^.es 1��p1. Fee Paitl S <br />Balan<e Duc S �(T` <br />-_��� �a���e�9�, <br />Zio Phone <br />City Zip Phone <br />Frojecl Address (il known) __ "J�' �7 y ��T�—f� /��/� ����-�—' <br />Ait2ch four (4) copies of plans for proposed work - Draw to scale and note the following as applicabla <br />• Property Lines <br />s Outline and dim,:nsions of 211 existing and <br />proposeJ structures on the lot <br />• Existinp and proposed utilities <br />• Cente�lin� of street <br />• Indicale North <br />• Show any proposed gradinc� changes <br />• Show measurements <br />PER�dIT CONDITIONS <br />�1. All calls for inspean ��: -hall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be perfurmed in accordance with !his permit and current City of Everetf Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-500-424•5555. <br />4.ANY CHANGH IN THE DRIVEWAY CUT MUST BE AFPROVED <br />BY THE PUBLIC WORKS INSPGCTOR. <br />5, COPZNECT DOWNSPOUTS TO mvorr n�.n.� ,,.� � r �.n L�� ���o,� �yh6L 5'{$t.��, <br />6.KEGY CITY �TREETS CLEAN AT ALL TIMES. <br />7.ANY DAMAGL+ TU THE CUf2B AND SIDEWALK WILL BE REPAIRED <br />TO 'PHE SATISFACTION OE THE PUBLIC WORKS DSPT. <br />��% <br />� <br />� ) j�/�� �� �, � <br />L <br />Appro�•r:d for Constructi � D te <br />G[x�-�/� /—%�' %�u <br />FINAL INSPECTION Date <br />Approved as Constructed <br />evr.rett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:255-8810 <br />ACKNOWLdUGEMENi OFCOND�'iONS <br />;� <br />� <br />v/ <br />0 <br />� <br />The undersi�ned owner/aoGlic��� ..rzUv agree: te hold'aod savn herm- <br />less the City ol Everet( irom e�r� �nd all clairnc for damac,es, ��est�, <br />expenses, or causes of action thai may arise because of ir.;;.���a; �.n <br />and maintenance of ihe improvement or o+her right-o(-way u;e hi:eto <br />applied lor and furiher agrees to removs same upon nn(ice Irom t'ne <br />�;ity anA to replace public property damxged �he•ehy. <br />�'�` � �y —� <br />Signature of A �licant Date <br />WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STJPFqGE OF WORK ON THIS <br />PROJEGT OVER 90 DAYS DURATION. <br />