7621 BEVERLY LN 2018-01-02 MF Import

Date_llzz/ 510 Application For PUBLIC WORKS PERMIT Print or Type Only Address Describe Proposed WurK 1. PubhC Welk$ Permd • ,V�— aldo Dept Pubs¢ Warks Fee Total Fea s -- LB--Appl Fea Paid S Balance Due S — Project Address (it kno.rn) �-- _- Attach four (4) copies of plans for proposed work - Draw to scale and note Cfo1lowing as of street • Property Lines • Irdicala North • Outline and dimensions of all existing and • Show any proposed grading :hanges proposed structures the lot • Show mecsurements • Existing and proposedd utilities PERMIT CONDITIONS 1. All calls for Inspection shall be made 24 hrs. In advance - phone 259.8810. 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 Undergrow:d Sorvice 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. Approved for Construction Date FINAL INSPECTION Date Approved as Constructed Everett PUBLIC WORKS DEPARTMENT 3200 Everett, WA Street Everett, WA 98201 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS W I- z O H O 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 installation 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. Signature of Applicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN ODAYS OF DIILIGENTLYDArE PERMIT IS ISSUED D PURSUED TOCOMPLETTION.TH STHEREAFTER BEPERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.