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Appli[etion For <br />PUBLIC WORKS PERMIT <br />�'rl n a Type Only <br />LJ�..f� . _�'�..�. � <br />oW�,�., <br />_ ia m t �--. <br />App�ICenl Mading AAdross <br />GiIY Zip <br />P.,�i�� W-v.n Perm�t • v � ��s �� _ <br />9ii:p DeOt � ���ic, <br />Puebc Wort� ca� <br />Tol�i res � __ <br />Let� �0�! Fee PnE f__ <br />Beienc� Due { � <br />Deecribe P�oposrd Work S/'� /S_, L, tl f • � (�e �� /� �, .t ry� <br />�j - <br />��/7— /�i., � _' <br />Pro�ect Address (il knownl <br />Attech fow (4� copiea ol plpns lor proposetl work - Urew lo scale and note Ihe lollowing as epplicable� <br />• F�operty Lines • Centc:lme ol sl:eel <br />• Oulline and dimeneions ol all e�isling end • IndlcalB North <br />proposed slructure6 on Ihe lot • Show eny propose: grading chnnr�es <br />• Erie�ing enA proposed ulllities • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls for inspnclion shell 6e mede 24 hrs. in ntlrenr,n � phone 259•88i 5 <br />2. All wOrk ehell 6e perlormed In eCco�denCS wilh �his pe�mrl cnd currnnt Cily of Everett Desiqn �nd Cons!r�d�nn <br />Stenderds entl Specihcationa. <br />3. Call Location Underground Service 41 h�x belore you diy. TO�.L FREE NUMBER 1-800•424•5555. <br />4. This lo[ depends un a 11fc c[a[lon for eani[ery sewer service. The City <br />has not accepted [he lift eta[ion for opern[ion and mnin[enance as of this <br />date. Occupancy oC rcaidence will no[ be all.owed un[il [he City accep[s <br />the lift s[a[i�n. <br />5. Down epou[e from [he house are to be tight—lined [o che curb drain. <br />6. Any grading of [hie lo[ Se to be done so as no[ to impac[ [he adjoining lo[e <br />with rain-water run-•off. <br />7. Sidewalk ie new .��d unbr�ken. Any dnmaRe to it will require replacemen[ by <br />[he applicant. <br />c4 FXi17iR.'(. ._. �%.E'./4•"sa�L� %l�t'.i/ �F <br />AQ/<�,PFjcydC'E�D k��r� ���c h�Ei6HT Cc�:d(' C-�-nE._� <br />d�n � 4 .3l�G•. /',t'cr'. y tU Ok'•� Enia y t'c � n9c,lT 6f <br />/�F.�' ['.T� ST.en,;�e.cJ "°�.it�?. <br />��� � <br />c.F ,!�-'�ve�� _ /"= /f<<S'C <br />. Approved lor ConaNuction Date <br />L���dP_n-z..J� � % "�"�'� <br />FINAL INSPECTIGN � Dale <br />Approved es Consirucled � �� <br />rverett PUBLIC WORKS DEPARTMENT <br />� 3200 CeUai S�ree� <br />Everatt WA 98201 <br />Phonn.259�d815 <br />,�f nT c^: � i �� <br />I�E2 S,Ati����0 <br />1�✓� icf t cE /� <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNGWLEDOEMENT OF CONDITIONS <br />The undersi9ned owner/eppGcanl he�eby epreea lo h�lA nnA snve harm- <br />le9s the Crty ol EoereV hom eny and ell tlnims for Aamnqr� r,osls, <br />expenses. nr cnuses ol aclion that mny erise becnuse ol insPilletion <br />and mamtnnence ol Ihe improvemenl or olher �ighbol�way u9e hereto <br />apPlled lor and lurther agrees to remove eeme upon nolice Irom the <br />City nnd to re ece public prope Iy deinegetl Iheraby <br />�- . � <br />� ' � <br />/ � <br />Sig urr ol Applica ate <br />WOFk AUTHORIZ BV THIS PEqMIT MUST BE STAHTED WITHIN <br />180 Df VS OF �ATE PERMIT IS ISSUED AND THEi7EAFTER IS TO <br />BE DlLitiEN7LV PURSUED TO GOMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ADIV STOPPAGE OF WORK ON ThIIS <br />PROJFCT OVER 90 DAV^ DUPATION <br />