20 SW EVERETT MALL WAY SCANLON CARPET 2018-01-01 MF Import

Date 3/� p Applicalion For PUBLIC WORKS P�'RMIT Print or Type Only Applican� Ci�y Cily Describe Proposed Work _- � r— �� —.S}�a co (!/1 nET S Project Address (it known) Attach four (4) copies of plans lor proposed �.vork • Draw to scale and note the lollowin� as aoolic�nin� • Property Lines • Outline and dimensions of all existin� and proposed siructures on the lot • Existing and proposed utilities Pu01¢ Worka Pe�mi1 a Bldg. Dept + v y� Pu01ic Works Fee Total Foe $ — . Less FOPL Fee PaiU S e�i,�a� o�e 5 • Cenlerline of sircet • Indicate North • Show any proposed grading changes • Show measurements Phona PERMIT CONDITIONS 1.All cails forinspection shell be made 24 hrs. in advance-phone 259•8810. 2. All work shal� be performed in accordance with this permit and current City of cverett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. beiore you dig. TOLL FREE NUMBER 1-800•424-555a. � G —{�� -�`:e..' wt � -T �� ��Z �� �?�,sz.c�c.�� Approved tor Construction Date FINAL INSPECTION Date Approved as Constructed everett PUELIC WORKS DEPARTMENT � 3200C:edarSireet Everett, WA 98207 Phone: 259�8810 ACKNOWLEDGEMENT OF CONDITIONS W � � � � O � V♦ O a The undersigned owner/applicant hereby agrees lo hold and save harm- less the Ci1y of Everett Irom any and all claims for damages, costs, expenses, or causes of action that may arise because of installation and maintenance of the improvement or olher right-of�way use hereto applied for and turther agrees to remove same upun notice from the Cily and to replace public property dama9ed thereby. Signature of Applicant Da�e WORK AUTHORIZED BY THIS PERMIT MUST BE STAqTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND TIiEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJCCT OVER 90 DAYS DURATIGN.