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Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only 00.2 <br />Mailinq Address <br />Describe <br />Project Address (if known) <br />14 <br />Public Works Permit a <br />Bldg Dept <br />Public Works Fee $ ^/O <br />Total Fee <br />Less Appl. ree Paid $ <br />Balance Due $ <br />Attach four (a) copies of plans for proposed work - Draw to scale and note 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 measurements <br />= i <br />Phone <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 current 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 />Approved as Constructed <br />11 everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />O <br />The undersigned owner/applicant hereby agrees to hold and oavo 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 imorovement 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 p operty damaged thereby. <br />Signature of Applicant Uate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF L iE 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 />