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I. <br /> � � <br /> DBtfi z�9�$8 PunbcWorkaPermn• eg _ <br /> . \ <br /> Application For eiec�oeP�.+ <br /> PUBLIC WORKS PERMIT PcOiicWOMaFee s�,a�— <br /> Total Fee <br /> Less Appl Fee Peitl S— <br /> print or Type Onry BalanceDue s.��- <br /> Canyon Lumber Co., Inc. P.O. Hox 1246 Everett, 98206 f206) 259-6036 <br /> Owner Mailing Address City Zip � Phone <br /> Canyon Lumber Co., Inc. P.O. Box 1246 Everett, 98206 (206) 259-6036 <br /> qpplicant Mailing Address City Zip Phone <br /> DescribeProposed Work #1. Gravel Everett Ave. right of way to suitable for crossing with Forklift. <br /> #2. Clean out ditch and install 30" Dia Culvert, approx 30' long. <br /> _ W <br /> Project Address�if known) �tween Evecett Ave. & Railwa Ave., See Plat Ma � <br /> Attach four(4) copies ot plans lor proposed work• Draw to scale and note tl�e 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 /> • Exisling and proposed utilities • Show measurements �� � <br /> i <br /> DO NOT WRITt BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•SS10. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.70LL FREE NUMBER 9-800-424•5555. � <br /> � �-�- u� ���w p <br /> , 1=� <br /> .,_�� V� <br /> �,- , O <br /> a <br /> AC;KNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> — — less the City ol Everett trom any and all claims for damages, cosls, i <br /> expenses, or causes of aclion thal may arise because of installation I <br /> � �� and maintenance of the improvement or otner right-of-way use hareto <br /> � applied for and further agrees to remove same upon notice Irom the + <br /> ve for � nsiru i n Date City and to replace public property damaged thereby. <br /> ` � � <br /> .� � - CCva�..�.��,r-.�vaw �.P �1 `� -�+ 1 i <br /> AL INSPECTIO Date � -�- �— � � � �y^pn,1� 7--�1b\�� i <br /> Approved as Constructed Signature of Appiican��8 Date � <br /> everett PUBLICWORKSDEPARTMEN7 WORK AUTHORIZED 9Y THIS PERMIT MUST BE STARTED WITHIN ; <br /> � 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street + <br /> Everett,WA982�J1 BE DILIGENTLY PURSUED TO COMPLETION. THIS PEHMIT MAY BE : <br /> Phor.e:259-BB70 CANCELLED GY THE C�TY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVFR 90 DAYS DURATION. <br /> I <br />