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/ <br /> � APPllcatior Frn —_�_ —' <br /> PUBLIC WORKS PERMIT Daie�i9� _ <br /> PUBLIC WORKS DEPARTMENT Public Works Permit x —�L/�v ' <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8810 Building Permit q _ <br /> 1`.'PE OR PRINT ONLY Public Works Fee$ �1 � � <br /> ��l��"S / /C+ � . <br /> Eldon M. Nysether 1'.0. liox 479 Everett, [JA 98206 (425) 259-0194 <br /> Ownar Mai�ing Address City Zip Phone <br /> Same <br /> F.pplicant Mailing Addreas Ciry Zip Phone <br /> Describe Proposed Work Placement uf crushed material (grindings from bridge work � <br /> in Everett) for finish grade on approx. 1 acre. (up to 500 yds. ) � <br /> N 97184 � <br /> ��� ��� 5,. -�� ' ' � � <br /> East sic:e of Smith St. from approx. ft. of <br /> PROJECTADDRESS(ifknown)Pacific south 250 ft. as shocm on a hed , in s. <br /> Atlach four(4)copies of plans for proposed work-Druw to scale and note the following if applicable: CASH 1� <br /> •Property Unes `Outline and dimensions oi a!I existing and proposed structures on ihe lot •Existing and proposed utilities G{� <br /> � �Centerline of street •Indicate NoAh •Show any proposetl grading changes •Show measurements A �1030 � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT C�NDITIONS: Z <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. O <br /> 2.All work shall be performed in accordance with thi;permit and current City ot Everett Design and <br /> Construction Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> �{, �Cee� �i� ��� �I.etv� �-� G�I ��n�r� . (� <br /> 5 (� 5¢F II �s;�'H Co��lrr l �� d�rrG�t;on o��b/,c .worKs ��Sr•cef y! O <br /> ✓ a <br /> � - � _ ACKNO�/LEDGEMENTOFCONDITIONS <br /> i � The undersigned owneda�olicant hereby egrees to hold and save harmless <br /> � the City of Everett from any and all claims for damages,costs,expenses,or <br /> ed f Co ructi pa� causes of action that may arise because of installation and maintenance ol <br /> l�u/�� the improvement or other right-of-way use hereto applied for and fuAher agrees <br /> to remov�, same upon notice trom the City and to replace public propedy <br /> �G .� ,y-� damaqed thereby. <br /> L INSPECTION Date <br /> Approved as Constructed � �j g'_�'1'7� <br /> i � �. <br /> ignawre of Applicant Date <br /> WORK AUTIIORIZED E3Y THIS PERMIT MUST BE STARTED WITHIN 1B0 DAYS OF DAT[PERMIT IS ISSUED AND TFiE FTER IS TO BE DILIGENTIY PURSUED TO <br /> COMPLEf10N.iNIS PEFMIT Iv1AY 0E CANCELLED BV THE CI'�Y UPON ANY STOPPAGE OF WORK ON THIS PROJE�T OVER 90 DAVS DURATION. <br />