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Date-L / <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Describe Proposed Work Nec.J SF� <br />Project Address (if known) L I <br />5E <br />Public W •Me Pmm" e � <br />Bido API. a <br />Public Work- Fee <br />i� <br />TFee <br />Lee- Aoot Fee Paid - <br />BelenceDue 1{ 42!e <br />Attach lour (4) copies of plans for proposed work • Draw to scale and note the Iollcwing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />* Conlerllne of street <br />• Indicate North <br />• Sr,cw any proposed grading changes <br />Ft Show measurements <br />dt0 /6 <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hire. in advance • phone 259.8815. <br />hla permit end current City of Everett Design and Construction <br />2. All work shall be performed in accordance with t <br />Standards and Specification& <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.55 . <br />�Constru�clionr�Date <br />Appr ed <br />FIIqAL INSPECTION Date <br />Approved as Constructed <br />[IPhone: <br />WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />W <br />0 <br />V / <br />O <br />a <br />ACKNOWLEnG:MENT OF CON 31TIONS <br />The undersigned owner/applicant hereby egret a to hold and save harm- <br />less the City of Everett from any and all cures for damages, cost& <br />expenses, at causes of action that may arlte because of Installation <br />and maintenance of the improvement or c'ner right-01-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replac Qpuubbliiccc property damaged thereby. <br />slur, of Applicant <br />St <br />IN <br />B0 DAYS OF AUTHORIZED PERMIT <br />WORK DATE PERMIT IS ISSUED AND THEREAFTER ISHTO <br />BE UILIGENTLY PURSUED TO COMPLETION. THIS PERf11T MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION <br />z <br />0 <br />•-1 <br />H <br />n <br />m <br />