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Date <br />/ i�P Pli�.ation Ra <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />S� <br />Pnbllc Work. Permit. <br />o <br />Bldg Dept . <br />Public vil Fee $ <br />T.1.l Fee <br />Lev eppl Fee v. a 5 ,2 <br />B.I.M. Dee 9 <br />4o2-322-st0-oo0-18-83/ <br />259-8800 <br />CITY OF EVERETT 3200 CEDAR STREET EVERETT WA 9820P Phone <br />Owner Mailing Atltlress Clty <br />SAME UTILITIES DEPARTMENT <br />mailing Address City Zip Phone <br />Applicant <br />ro Filling an area to construct fire lane and bike path at 41st and Smith <br />C y Describe Proposed Work <br />Street. site of Smith Street Bride 2,000 cubic yards of fill material. See attached <br />1 <br />tan. 1 U <br />Project Arens of knOWnl <br />4100 Smith Street S <br />Address <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />e� <br />• Property Lines • Centerline of street <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 O <br />rill' PERMIT CONDITIONS r^ <br />1. All calls for inspection shall be made 24 hr& in advance •phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />I Standards and Specifications. <br />3. Call Location Underground Service 48 hire. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />s; L/ <br />Cone <br />', ! rcY'�q/�� 4rj/ rlecrssary G'rosiui, � S'r-c)/i.na� •i•' <br />qs a/ii'.-c�cor 6y -fhe Gov/L/c an/,Er jnsp�c7'co/^ H <br />V t/ <br />12/13/90 4:30FM OODAR4949 0 <br />H00000510 Q. <br />DPT.20 <br />1 C{iSH $0.00 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save arm- <br />► less the City of Everett from any and all claims for damages. costs. <br />1 1 a expenses, or causes of action that may arise because of installation <br />0 and maintenance of the improvement or other right-of-way use hereto <br />� applied for and further agrees to remove same upon notice from the <br />Approved for Co gtruction ) Date City and to replace public property damaged thereby. <br />V <br />�c is 73 vv <br />FINAL INSPE ION Date Date <br />Approved as Constructed Signet e o Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />c�Vrett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />E1� Phone: 259-8810 PROJECT OVER 90 DAYS DURATION. <br />