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Date��� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />(3,PDnPM) - <br />Owner <br />Public wares Permit •p p.88 <br />Bldg. peat • —'- <br />nIS�— <br />Pubkc Works Fee <br />Total Fee S <br />Less Abbt Fee Paid $ ^� <br />Balance Due S ' <br />Phone <br />SD em P Phone <br />Applicant Mailing Address GIIY zip <br />Describe Proposed Work <br />Project Address (it known( <br />_ -? 2!9, <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 />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • 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 shall be performed in accordance with this hermit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />4•ANY CHANGE IN THE DRIVEWAY CUT <br />BY THE PUBLIC WORf:S DEPORTMENT <br />5.USE PUBLIC DRAINAGE SYSTEM AS <br />b.ANY LOT GRADE CHANGES MUST BE <br />PUBLIC WORKS INSPECTOR. <br />7.1;EEP CITY STREETS CLEAN AT ALL <br />MUST BE APPROVED <br />PROVIDED FOR DOWNSPOUTS. <br />APPROVED BY THE <br />TIMES. <br />� 1G703/- — 61131. <br />"Ic^ _ <br />Approved for Constr ction Dr <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />Ever tt.WACedaStreet <br />Everett WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />LU <br />♦FM <br />Y / <br />a <br />The undersigned owner/applican' 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 of action that may arise because of installation <br />and lainte�:nce of the mprovement or other right-ol-way use hereto <br />applied to- and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signatdfe of Applicant f 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 WORK ON THIS <br />PROJECT OVEF 40 DAYS DURATION. <br />