1808 DULL PL 2016-01-01 MF Import

✓ r — . � Publit Wo�ks Per • �` �/ Date `� I Biae� oeo�. • Application For PUBLIC WORKS PERI°JIIT Print or Type Only Address Describe Proposed Work Proiect Address (it known) Puol¢worksFee S totei Fee Less Appl Fee Pab $ � oe�e��eo�a S ��'� 33�-��/. Zip Phone Attach tour (4) copies of plans lor proposed work • Oraw to sc�le and note the lollowing as appllcable: • Property Lines • Centerline of street • Out�ine and dimensions of all existing and � Show any Proposed grading changes proposed strucWres on the lot � Show measurements • Existing and proposed utilities PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 5. 2. All work shail be pe��ormed in accordance with ihis permit and current City of Everett Design and Construction StandarcJs and Specifications. 3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. Approved as Construcled everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Slreet Everett. WA 98201 Phone:259�8815 ACKNOWLEDGEMENT OF COfJDITIONS � O � � O a The undersigned owner/applicant hereby agrees to hold and save harm• less Ihe City ol Everetl Irom any and all claims for damac�es, costs, expenses, or causes of action that may arise because ot installation and maintenance ot lhe improvemenl or other right-ol�way use hereto applied for and furiher agrees �o remove same upon notice Irom ihe Ciry and to replace public property damaged thereby, Signature ol Applicant Datc WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMII� IS ISSUED AND THEREAFTER IS TO BE DIL�GENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATIO�.