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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />C C <br />Public Works hermit a <br />Bltlg. Dept. <br />Public Works Fee <br />Total Fee S �' n <br />Less Appt Fee Paid $ - <br />Balance Due s 2:9' 0 <br />0 <br />City Zip Phone <br />oo(M J C�fCt boy ICOOL4 <br />City zip Pho?ee- y,'5 '1 ,2A <br />Describe Proposed Work CL<--a6.1 <br />Mailing <br />Project Address (if known) c---�JIV c. J L U r* A; h <br />Attach fc-ir (4) copies of plans for proposed work - Draw to scale and note the following as applicable <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any prcposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />DO 120T WRITE BELOW <br />THIS LINE <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 eulrent 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 />for <br />FINAL IRSPECTION \" <br />Approved as Constructed J <br />cverett PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />z <br />O <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <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 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 'o remove same upon notice from the <br />Dat I City and to replace public progeny damaged thereby. <br />cligna(ure or AIm / uate <br />VVUR�O IZED BY THIS PERMIT MUST BE STARTED WNHIN <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 />