8015 BROADWAY 2018-01-02 MF Import

Date4i:4 Application For PUBLIC WORKS PERMIT Print or Type On!y Applicant Public Woks Permit a Bldg. Dept. e a 7 ,4f 3L0 Public werka Fee rule' Fee S Less ApPI Fee Pei S Bala,,ceDue $ �L7 Zip P ity Zip Describe Prcposed Work R.4 P O f�1rPi Project Address (if known) Attach four (4) copies of plans for proposed work - Draw to scale • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities PERMIT CONDITIONS the following as applicable: • Centerline o1 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 Specifications 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. Approved for Construction Date FINAL INSPECTION Date Approved as Constructed everetl PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8815 ACKNOWLEDGEMENT OF CONDITIONS W H O H N 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 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.