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Date —Lk —.44 M <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Works Permit s g�_tY� ,7.[—y/� <br />Bldg. Dept... 8•' .�y— <br />Public Works Fee $ <br />Total Fee <br />Less Appt Fee Paid $ <br />Balance Due s > <br />ksem,.n AAdrnse Cuy Zip Fri <br />Applicant <br />Mailing Address Citv Zip Phone <br />Describe Proposed Work <br />- W <br />Project Address (if known) A9/14 <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />1 Outline and dimensions of all existing and • Indicate North <br />a <br />oroposestructures on the lot • Show any proposed grading changes <br />•Show measurements <br />• Existing and proposed utilities <br />DO NOT WRITE BELOW THIS LIIJE O <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs, in advance • phone 259.881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Underground <br />s. <br />3. Call Location Underground Service 48 hrs. balers you dig. TOLL FREE NUMBER 1.800.424.5555. <br />4. Curb, gutter, and sidewalk are nevr & unbroken, any damage to them shall <br />be repaired/replaced by the applicant. <br />5. Any driveway location changes must be approved by the Public 4torks Dept. ■ <br />and inspected prior to construction. rr <br />6. Use public drainage system provided fr: roof -ton downspouts. 0 <br />I <br />�a <br />Approved for Construct! D�Ya <br />FINAL INSPECTION Date <br />Approved as Constructed <br />I <br />tt PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />le Everett, WA 98201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any r.nd 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 />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST F. 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 UFON ANY STOPPAGE OFW RK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />