1216 50TH ST SE CENTURY 21 2018-01-02 MF Import

Date�� Application For PUBLIC WORKS PERMIT Print or Type Only F; tq Describe Proposed Work Project Address (if known) Attach four (4) copies of plans for p�,.N��ed work - Draw to scale and note the following as applicable: • Property Lines • Outline and dimensions of all existing and propoced structures on the lot • Existing and proposed utilities PERMIT CONDITIONS Public Woiks Permd a Bltlg. Dept. • — � Pubtic Works Fee 'olal Fee $ — Less ApC�- Fee PaiU $ Balance Oue $ • Centerline of street � Indicate North � Show any proposed grading changes � Show measurements 1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction Standards and Speci(ications 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. PU/3C�G ��vo,P,�l' t�'E�/'niT �rJor l�f�v..e�,e Approved for Construction FINAL INSPECTION Approved as Constructed everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 9820t Phone:259•8875 Date Date / �� �-- ,L�/�i ACKNOWLEDGEMENT OF CONDITIONS � O � � O a The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett irom any and all claims for damages, costs, expense;, or causes of action ihat may arise because of installation and maintenance of the improvement or other right-ohway u�: hereto applied for and furiher agrees to remove same upon notice from the City and to replace public properry damaged thereby. Signature of Applicant Date WORK AUTHORIZED BY THIS PERNIT MU6T BE STARTED WI7HIN 180 DAYS OF DAT� PEFMITIS ISSUED AND THEREAFTER IS TO BE DILIGEMTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.