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Date <br /> Pubic Wdru Pari <br /> —1 Apphl:Tlion rni Bldg Derr <br /> PULIC WORKS PERMIT Pubic Works Fee <br /> g Talel Fee S <br /> ae( Q Q p p p p Leu APPI Fee Ped S <br /> Print or Type Only g r� O O�� O Beence Due S z� <br /> IfOI I � � $ �� � � <br /> �l m 9; 0 M . � ere Nr <br /> Owner /Mg <br /> wnerg �N& . <br /> C it <br /> ti 1 y Zip Phone <br /> Applicant Mailing Address City '.ip Phone <br /> Describe Proposed Work �C__ (�f' 1/ � �c '7�—•` �P}����� <br /> lJ <br /> Protect Address(11 known) -- Oi — t..e 1 ST1Z SE LU <br /> Attach four(4)copies of plans for proposed work•Draw to scale and note the lollowing as applicable: <br /> • Property Lines • Centerline of street Nissan� <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE Im <br /> PERMIT CONDITIONS O <br /> 1.All calls for Inspection shall be made 24 hrs.In advance•phone 259-8810. 0 <br /> 2.All work shall be pertorm�d in accordance with this permit and current Clty of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.6^0.424.5555. z <br /> 4.ANY CHANGE IN THE DRIVEWAY CUT MUST BE APPROVED <br /> BY THE PUBLIC WORKS INSPECTOR. <br /> 6.CONNECT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. H <br /> B. KEEP CITY STREETS CLEAN AT ALL TIMES. <br /> 7.ANY DAMAGE TO THE CURB AND SIDEWAL., WILL BE REPAIRED <br /> TO THE SATISFACTION OF THE PUBLIC WORKS DEPT. <br /> Q <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages. costs, <br /> n expenses, or causes of action that may arise because of InWallation <br /> and maintenance of the Improvement or other right-of-way use hereto <br /> Approved for"ConsIn applied for and further agrees to remove same upon notice from the <br /> Approved forDate City and to replace public property damaged thereby. <br /> heFINAL INS ECTION Data <br /> Approved as Constructed Signature of Applicant Date <br /> W <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY A PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259.8810 CANCELLED BY THE CITY UPON ANY STr,,PPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />