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Date -V3/J(o <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />S1�, <br />Mallmg Aooress Cily Zip <br />Crarl i A C li %H4 Non.I s 7j 3 Qf ac <br />Applicant Mating Address City Zip <br />Describe Proposed Work <br />Project Address pf known) in V ` <br />Public ll Pvme I 86 — 81 <br />aldy. peel. I 8G l / t. 1 a0 <br />PubllC Worea Fes <br />Total Fee ✓< <br />Less APPI Fee Peld f< <br />Balance Due <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 />I. All calls for inspection shall be made 24 hra in advance - phone 259.8815. <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. TOLL FREE NUMBER 1.800.424.5555. <br />4. ANY GRADING DONE ON THIS CAT SHALL BE DONE SO AS NOT TO IMPACT THE <br />SURROUNDING LOTS WITH RAINWATEk RUNOFF. <br />5. ANY CURB & GUTTER OR SID':WALR DAMAGED DURING CONSTRUCTION SHALL BE <br />REPLACED BY TFE A°PLICANT. <br />Approved for Construction Date <br />FINAL INSPE� N vI Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />Everett, WA 98201 <br />Phone: 250.8815 <br />ACKNOWLED3EMENT OF CONDITIONS <br />O <br />The undersigned owner/apollcont herebyagrees to hold and save harm• <br />less the City of Everett from tiny and all claims for damages, costs, <br />expense& 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 sam upon notice from the <br />City and to replace public property damaged thereby. <br />r <br />��� <br />Siraters of Applicant D: •e <br />WORK AUTHORIZED Y THIS PERM T 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 OVER 90 DAYS DURATION. <br />