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Date 2/4/91 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Wort Permit <br />Bldg Dept • 91/26389 _ <br />Public Worka Fee a <br />Total Fee <br />Lesa April Fee Paid S <br />Balance Due • <br />city of Everett 3002 Wetmore Everett, oa nl ?Ro-14700 <br />Owner Mailing Address City Zip Phone <br />Owner <br />Applicant Mailing Address City <br />Phone <br />Describe Proposed Work Municipal Court — addition for electrical room a retaining wall <br />Project Address (if known) <br />W <br />H <br />Attach four 141 copies of plans for proposed work - Draw to scale and note the following as applicable: <br />Approved <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hm. 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 />Standards and Specifications. <br />3, Call Location Underground Service 48 hrsbefore you dig. TOLL FREE NUMBER 1.800-424.5555. <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everele tt, WA 98201 <br />Phone: 259-8810 <br />O <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 />expenses, or causes of action that may arise because of installation <br />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 />Date City and to replace public proparty damaged thereby. <br />Date <br />ure of Applicant <br />Date <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 />PROJECT OVER 90 DAYS DURATION. <br />