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�~ Bldg Works Perm <br />DateJ� ��� <br />Blau. onPr. + <br />Application I Or <br />PUBLIC WORKS PERMIT Pub <br />Total FeeFao $ - <br />Less APPI. Fee Pele 8 <br />Bolence Dun $ <br />Print or Type Only <br />Phc no <br />Describe Proposed Work <br />Project Address (d known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and ncte the following 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 measure nents <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 his, 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 Specificatiors. <br />3. Call Location Underground Service 48 hrs. before You dig. TOLL FR N MBER 1.800.424.5555. <br />z <br />0 <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant 'ereby agrees to hold and save harm- <br />less the City of Everett from or-., 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 othar right-of-way use hereto <br />applied for and further agrees to remove same upon notice 'rom the <br />for Construction Date City and to replace public property damaged thereby. <br />FIN/L INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 982018201 <br />Phone: 259.8815 <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 DURATIGN. '--� <br />