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Date�%�%Q/ <br />/ / <br />Applicalion For <br />PUBLIC WORKS pERMIT <br />Print or Type Only <br />�-7�- _ <br />i�„e.. nn.cr�/��,,.�i 7� ---- <br />nino omi • -1.�� z ✓- �_1]--__ <br />n,���i��: wo��e re� <br />,��,� �A� s -- <br />�c+aeom �•ern�a S <br />e.,i,��.o�0 5 Z-O�— <br />l.;a.oiin L)�r �(��'¢��5�/�,� ��i��i - zPz�_6_�.'a'- -_So/ <br />ner MadinyAtldress Giy Zip PI ��e ;�� <br />rt <br />S p vrl � --- �;�'�` <br />qpplican� Id:uhnqAddress Cily Lp >�,one <br />Oescribe Proposed Work ��/:I�JI��( -�i �rlJ V(!C �' � � ��� <br />/ � <br />P�oiecl 4ddress pl knowN �3 � / r� �t"l� S <br />Altach low (G� copies ol plans br proposed work � Draw lo scale anA no�e Oie lollowin9 as appllcabl�r <br />• Pro�+erty Lines <br />• Oulline anA dimensions ol all caistmc� anA <br />proposed sfrudures on the lol <br />• Exisling 2nd ��oposed ulililics <br />• Centerline ol 5treel <br />• InAir.atc Norlh <br />• Show any pronosed cpadinq chanycs <br />• ShoW mCaSurcmenl5 <br />PERMI' CONDITIONS <br />1. All colls �or inspectioe shall be made 24 hrs. in advance � phone'lb9•BBi O. <br />2. AI work shall be Gr,rlormed in ncwrdance with IhiS permil and curreM City ol Gverett Design and Consuuction <br />Slendards end Specilicati�ns. <br />3. Call Location Undergrountl Service 4B hrs. belore you dry TOLL FREE NUMBER 1•800•424•5655. <br />4. Install rock construction entrance behind driveway as per city <br />standard N208 to reduce tracking mud onto streets and erosion <br />cnntrol as directed by Public Works Inspector. <br />5. Keep city street�s clean at all times. <br />6. Curb, gutter and sidewall; in the plat are new and undamaged. <br />any damaqe ttieretp shall be replaced at the dis�retion of the <br />Piibl ic Works Inspe�k�r. <br />7. Any change in the drivewav cut must be approved by the <br />P�.il�lic WorF:s [nspeclor. <br />8. Tiqhtlina all root, yard and driveway drains from houses to storm <br />dr-ain stuhs at back ot side walk with rubber gasAet P.V.C. pipe. <br />9. Ad7ust w��ter boxes to grade at end of construction. <br />10. Dri.veways shall he rompletely cure., before drivinq on them. <br />`-��,�,��2 ��1 ��� 2- z s=� i <br />Approved lor Guns�fuction Da�e <br />�z''�� �./S�-y� <br />FINAL INSPFCTION ����� <br />AnP�oved as Conslrucled <br />�•��•��.❑ PUBLICWORKSDEPARTMENT <br />� 3200 Codar Slreel <br />Evcrett, WA 98201 <br />Phone�.2i9�8810 <br />ACKNOWLEDG[MENT OF CONDITIONS <br />� <br />0 <br />1 <br />Y / <br />O <br />a <br />1 he undersignetl ownei/applicin� hereby a,yrees lo holA and save hann� <br />less the Cdy ot [vr.iett lion: any and ;dl claims for dama9es, costs. <br />expenses, or causcs ol actwn that may arise ber.nus� ot installahon <br />ai.A maintenance ol the improvement or othm nght o�-wny uso homlo <br />2pphcA lor and lurlher Tgrees to removc snmc ��pun nodrr liom Ih�� <br />Gty nnr to replace pub6r, property damaged ihemhy <br />Si�na�u�. .hcn�� ____ Dal�,_— <br />WORK AUTHURIZED BV THIS PE IT MUST 8E STARTED WITHIN <br />180 DAVS OF DATE PERMR G ISSUED AND TH[REAFT[R IS TO <br />�[ DILIG[NTLV PURSUEO TO COMPLETION. THIS P[RMIT MAV BE <br />CANCELLED OY THE CITY UPON ANV STOPPAGF. OF WORIt ON THIS <br />PRO.IfCT OVER 90 UAVS DUf7Al1(1N <br />