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1 <br />Date <br />Application 1 01 <br />PUBLIC WORKS PERMi T <br />Print or Type Only <br />Describe Proposed Work <br />Project Address ill known) -2UTa= <br />Public Works Permit • ��—�/� <br />Bldg Deer <br />Public Works Fee d <br />Total Fee <br />Less AWL Foe Paid Q <br />Balance Due >{ 20 OO <br />. 9 <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Online end dlmencions 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 />PEHMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hre. 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. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />tt PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />e I Everett, WA 98201 <br />J Phone: 259.8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />m <br />"IT <br />N <br />O <br />( C) <br />�/ <br />Or <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, cost% <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 therapy. <br />Signature of Applicant a..-....f 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 />