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���Ltv, J <br />Application For <br />PUBLIC WORKS PERMIT <br />fni , F�UEUC WORKS DEPARTMENT <br />D *20p Cedar Street <br />11 p { yt7 Elve6t, VJA 98201 259.8810 <br />TYPE OR PRINT ONLY <br />-11-TT <br />._.- clr�,r�_r.harv,:Atkm,.- I -,•T— d-1'>,n /,/% <br />Date <br />Public Works Permit a —L— �,? $ <br />Building Permit # <br />Public Works Fee S <br />7�/ <br />Describe Proposed Work <br />J_ <br />PROJECT ADDRESS (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following I' applicable: <br />•Propeny Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br />•Centerline of street -indicate North •Shaw any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />4. Install construction entrance per city standard #208. <br />5. Install silt fence per city standard #205A at location shown on plans <br />6. Install catch basin/inlet Ifedimentation trap and filter for existing <br />structures as required. <br />7. Keep city streets clean at all times. <br />Approved as Constructed <br />n <br />to <br />V) <br />co <br />O <br />z <br />O <br />05/15/97 3:27PK OOOAft1239 kK.k'K <br />000097125 <br />OTHER $35.00 <br />000097126 <br />OTHER $35.00 <br />k00097127 <br />OTHER $35.00 <br />CHECK $105.00 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERb4 IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />