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Date /Z Z � <br />�-2-28-4 <br />ApplicationFor TO PQ�TING �-z�� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />94 ^' .--- <br />PUCIic Works Permll • �%(J� <br />eieo. oem.. _ q3//� <br />P��Ellc Norke Fee <br />TtIelFee S <br />Leea AppL Fae Paitl S �J� <br />Balance �ue f _ �.(/ ^ <br />Describe Proposed Work <br />Project Address (it known) L?/f'J " <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate NOAh <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />,, � 1. All calls for Inspectbn ahall be made 24 hra. in advance - phone 259-8810. <br />i 2. All work ehall be performed in accordence with thia permit and current City of Everett Dee;gn and ConstrucHon <br />Standards and Specificationa <br />� � 3. Call Lxation Underpround Service 48 hrs. befare you dig. TOLL FREE NUMBER 1-800�4245555. <br />, � 4. knld rock comlruction �ntnncs behind d►ivwwy as per city <br />standard �08 and erotion coMrol a: dirocted by Pubic Works <br />i Intp�afw. <br />5. Ksep cMy slroets ckan al al timea <br />� 6. Curb putter and NdeYwk in ths pW aro new and undamaped, <br />ary dama� theroto shal bs mpaced at thE discrefion of the <br />, ' Pubfc Works M:p�ctor. <br />1. My chsnpe in the drive�vy cut musf be apprn,ed by the PW In- <br />cpsctw, widlh at prop In� ImN�d to �dpiny apron widlh. <br />8. ConMct sl roof, yard and driveYwfy drNna to stortn drain <br />sysbm proNd�d to lot. <br />9. AdJusf weler boxes to gnde at end ot condruction. <br />10. Driwv�nys shal bs compkS�y ourod be(oro d►ntinp on them. <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 CederSheet <br />Everett, WA 88201 <br />Phone:259•8810 <br />Qi 05 <br />Date <br />G -i�•�3Y <br />Date <br />ACKNOWLEDGEMENT OF CONDITIUNS <br />v <br />� <br />W <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersi9ned owner/applicant hereby agrees to I:old and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other righhof•way use hereta <br />applied for and further agrees to remove same upon notice f�om the <br />City and to replace public property damaged thereby. <br />. � / �„ 1 � <br />Signature of Applicant ��� ��—�� <br />WORK AUTHORIZED BY 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 STOPPAGE OF WORK ON THIS <br />PROJFCT OVER 90 DAYS DURATION. <br />