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Date_�.�� °, I <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Addre:;s <br />Mailing <br />Describe Proposed Work �A 1 ,��� ` <br />Project Address �if known) <br />City Zip <br />Attach lour (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of a�l existing end <br />proposed structures on the lot <br />• Exisling and proposed utilities <br />PERMIT CONDIT�ONS <br />Publlc Wa�ks Pa�mii • �+ � � �� <br />Blap. Oepi. � ��T'� <br />� <br />Publit Warb Pee <br />Tolal Fea S <br />Less Aou� Fea PaiE $ <br />eaiancooao S_r�10 ao <br />� Centerline of streot <br />� Indicate North <br />• Show any proposed gratling changes <br />• Show measurements <br />?. Ail cells for inspaction shell be made 24 hrs. in advance • phone 259•8815. <br />2. All work shell be performed in accordance with this pennit and current City of Everett Design and Construction <br />Standards end Speciticationa <br />3. Call Locetian Underground Service 48 hrs. before you dig. TOLL FREE NIJMBER 1•800•424-5555. <br />STREETS ARE TO BE KEPT CLEAR OF A1�L MUD�GRAVEL�AND MISC. DEBRIS AT <br />ALL TIMES, <br />FAILURE TO KEEP THE PUBLIC R.O,W, FREE OF DEBRIS AND/MUD OR G <br />WILL RESULT IN THE IMMEDIATE POSTING OF <br />PROJECT WHICH WILL REMAIN IN FORCE UNTIL <br />IS COMPLETED TO THE SATISFACTION OF THE <br />J <br />FINAL INSPECTION <br />Approved as Consiructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />�7 <br />RAVEL <br />A STOP WORK ORDER ON THE <br />ALL CLEAN UP OF THE R,O.W. <br />PUBLIC WORKS INSPECTOR <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the Ciry of Everett trom any and all claims for damages, costs, <br />expenses, or causes ol action that may arise because of insteltetion <br />and maintenance of the improvement or other right•of-way use hereto <br />applied for and further agrees to remove same upo� notice fram the <br />City and to replace public property damaged thereby. <br />������.� �o-� -�� <br />Signat re o Appli t Date <br />WOFiK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER �S TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PENMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. " <br />