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Date O"2, 8b <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />Describe Proposed Work <br />Project Address (if known) <br />Public Works Permit s <br />Bldg. Debt. a <br />Public Works Fee $ G} <br />Total Fee <br />Lose AppL Fee Paid $ — <br />Balance Due $ ��— <br />svzs 15214 aw- s,G7 BPAuuue vA gvev& eA3 k_;w <br />Attach four (4) copies of plans for proposed work- Draw to scale and note the following as applicable: <br />• Property Lines • Cente•line 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 259.881 5. <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 Service48 hrs. before you dig. TOLL FREE NUMBER 1 -800.424.5555. <br />L <br />tt PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />I- <br />I� <br />Cn <br />an <br />0 <br />H <br />V) <br />O <br />a. <br />The undersigned owner/applicant 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 actiop that may arise because of installation <br />an maintenance of the imprdvement or other right -of way use hereto <br />ap fed for and further agree to remove same upon notice from the <br />Cit and to replace public pro arty damaged thereby. <br />WORK AUTHORIZED BY THIt PER)ilp MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS I S ED AND THEREAFTER IS 70 <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 />