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Date��i7� <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Pri��t or Type Only <br />nnaumg ntltlress <br />Describe Proposed Work <br />Project Address (i( known) <br />up <br />Atlach four (4) copies ol plans tor proposed work • Draw to scale and note �he following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing an� <br />proposed structures on the lot <br />• Existing and proposed utilities <br />Publir Works Permlt a_ ��y�— � T <br />Dldg. Oepl. s Q.J <br />Publ¢ Worke Feo <br />Total Feo $ — <br />Le55App1 FeePeiA $ <br />BalancaUue $ ��� <br />• Centerline of street <br />• Indicale Norih <br />• Sh�w any proposed grading changes <br />• Show measurements <br />Phone <br />PERMIT CONGITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. All work shall be performed in accordance with ihis permit and current City ot Everett Desinn and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•4T.4•5555. <br />evere[t PUB�IC 4VORICS DEPARTMEN'f <br />� 3200 Ced2r Sireet <br />Everett, Wh 98201 <br />Phone:259-8810 <br />ACKNOWLEUGEMENT OF CONDITIONS <br />W <br />F- <br />� <br />� <br />� <br />The undersigned owner/applicanl hereby ag�ees to hold and save harm- <br />less the City ol Everett from any and all claims lor damages. cosis, <br />expenses, or causes of action that may arise becnuse of installation <br />and mainten�nce of the improvement or other right-oFway use hereto <br />applied lor and further aqrees to remove same upon notice from ihe <br />Ciry and replace public properry dama9ed there6y. <br />1� �o �� <br />�riat e of pp � an � Date <br />AUTH IZED BY THIS I'ERMIT MUST B STARTED WITHIN <br />0 D4YS F DATE PERMIT IS �£SUED AND THEREAFTER IS TO <br />BE DI�!GENTLY PURSUED TO CO�APLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITI UPON FNY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />