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Date�`� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br />Describe Proposed Work <br />Project Add:P,.s (if known) <br />C <br />Zto <br />Public Works Permit Qa ��.. �� �. <br />Bldg. Dept. is_E /67 � <br />— <br />Public Works Fee S <br />Total Fee <br />Less Appt Fee Paid $ <br />Balance Due <br />Attach four (.) copies of plans for proposed work - Draw to scale and note the followifig 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 />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All rcerk shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-42.4-5555. <br />�. 8 <br />Approved for Construction <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLICWOHKS DEPARTMENT <br />Ever Cedar Street <br />le Everett, WA 98201 <br />Phone: 259.8610 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />�Ittttt� <br />NO <br />0I• <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 to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT 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 />