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/ '— Q <br />Date `�t�U <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />Pu�lit Wo�Fs Permil • �� �� <br />eiae. oeo�.. �� ��.L.� <br />PuClic Wa�ks Fee $ <br />Talal Fea <br />Less Appt Fee P.,ia $ -.�� <br />Bnlanca Duv S � <br />City Zlp rnone <br />Describe Proposed Work ��� �� �r� �� �� ��� � <br />Prolect Address �if known) <br />Attach four (4) copies of plans for proposed work • Draw to scale and note lhe tollowing as applicable: <br />• Property Lines .• Centerline of street <br />• Outline and dimensions of all existin9 and • Indicate Norih <br />propused structures on the lot • Show �ny proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in dvance • phone 259-8815. <br />2. All work shall be performed in accordance with this permit a�d current City of Everett Design and Construction <br />Stanct�r�ts and Specilications. <br />3. Call .,oation Underground Service 48 hrs. betore you dig. TOLL FREE YUMBER 1•800•424•5555. <br />STREETS ARE TO BE KEPT CLEAR OF ALL MUD�GRAVEL�AND MISC. DEBRIS AT <br />ALL TIMES. <br />FAILURE TO KEEP THE PUBLIC R.O.W. FREE OF DEBRIS AND/MUD OR GRAVEL <br />WILL RESULT IN THE IMMEDIATE POSTING OF A STOP WORK ORDER ON THE <br />PROJECT WHICH WILL REMAIN IN FORCE UNTIL ALL CLEAN UP OF THE R,O.W. <br />IS COMPLETED TO THE SATISFACTION OF THE PUBLIC WORKS INSPECTOR <br />�Emovc Exis>��G� O.�i[�Ew�l�/ Curu� CUT �,Z Ci�r <br />S�EG. j°` 3..� 7 AND 1.e/Si9GL� .uEs�J 1i,t��✓ENFJd �F,� <br />/ <br />C�Ty OF E�/EnPElT ST�9rvA9.C'O �.y�7, <br />„ � �� 5� /"�'� 7 <br />Approyed for Constru Kon C�� Date <br />, � �„��j <br />F SPECTION Dete <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ow�er/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 ol action that may arise because of installation <br />and maintenance ol the improvement or other righFof•way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace pu6lic property damaged ihereby. <br />n � <br />� � / � 6 7 <br />� .���.��1.�',.� L � - � ) v <br />.� <br />Signature of A cant 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 \VORK ON THIS <br />PROJECT OVER 90 DA1'S DURATION. <br />