8016 BEVERLY BLVD 2018-01-02 MF Import

Date**/9 Application For PUBLIC WORKS PERMIT Print or Type Only RobEal R. PiE Owner SAME Applicant Describe Proposed Work ✓ �rPi✓f� in Project Address (if known) Mailing Address Mailing a tally Zip PobLc Works Permil a 2F -3-5 Bldg Dept -I __ Pub.c Works Fee s Tclal Fee Less Appl Fee Peitl S n� eaiance Due S n Attach four (4) copies of plans for proposed work - Draw to scale and note the following as appli„able: O Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls for Inspection shall be made 24 firs, 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 Specifications. 3. Call Location Underground Service 48 his, before you dig. TOLL FREE NUMBER 1 .800.424.5555, 5<, 1vs7-S- A�'6 var- ON r"1-1 104-d L le Approved for FINAL INSPECTION \ J Approved as Constructed v everett PUBLIC WORKS DEPARTMENT Ever Cedar Street Everett, WA 98201 Phone: 25^ 9815 Date Tv lie 1-irlSTeLLFf� - e� - r r/.,y. ACKNOWLEDGEMENT OF CONDITIONS W z 0 N 0 a The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett from any and all claims for damages, costs, expenses, or causes of action that may arise because of installatio.i and maintenance of the improvement or other right-of-way use hereto applied for and further agrees to remove same upon notice from the City and to replace public property damaged thereby. V �/� a'C - - JI Ao Na„ /Olyr Signature or Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.