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Date�-d' d <br />Applira:ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />yh <br />59 <br />Public Works Permit a <br />61d0. Dept.. �g�i q - <br />Public Works Fee $ <br />Total Fee <br />Less Appi. Fee Paid S Balance Due $ �� l <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />Project Address if known) <br />3r <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shot! be performed In accordance with this permit and current City of Everett Design and Construction <br />Standards Prld Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig.1 OLL FREE NUME ER 1.800-424-5555. <br />4. Use driveway curb --cuts provided or get approval _ro:a the public Works <br />Inspector for relocation. Any new driveway shall be installed per City <br />Standard #307. Unused driveways shall be taken out rnd rep]ncr.d with <br />fullheight curb and gutter. <br />5. Use storn1 drain system for down -spouts from roof top. <br />6. The applicant shall be responsible for replacing any curb, gutter or <br />sidevalk broken during the construction process. <br />i <br />Appruved for <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />UJ <br />rfrfrfrfr� <br />_M! <br />W <br />Ili <br />M <br />The undersigned owner/applicant heteby 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 />City,and to replace public properly damaged thereby. <br />�\ ll�� d&WLI /G/i <br />SignaMre of Applicant / Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEQ%,IT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURE UED ; O COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />