2315 W CASINO RD 2018-01-02 MF Import

)ate 3 11•l9P� Application For PUBLIC WORKS PERMIT Print or Type Only Owner Applicant Mailing Address Public Wort Permll Bldg part Pu0bc Worq Fee • �l 77 Total Fee G Leas April Fee Pnd • � �� _=_ Balance Due 8 29___ Address City Zip Phone Describe Proposed Work _C...LEHR L�_�fiflE pN� �'.LLL_s1P�0 3rQfLQ Lu, VUS ON AMONAUELY 3 Ar?c c1r-E. LIDNSTQLICTION OF AN bN SIT Project Address lit known) _ Attach four (4) copies of plans icl proposed work - Draw to scale and note the following as applicable • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lct • Show any proposed grading coanges • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls for Inspe-llon shell be made 24 r in advance- phone 259.8810. 2. All work shall be performed in acco,aancrl W,lh this permit and current City of Everett Design and Construction Standards and Specifications. 3. Cell Location Underground San icr,:8 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. W H O z O CO) 0 a ACKNOWLEDGEMENT OF CONDITIONS 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-obway use hereto applied for and further agrees to remov area upon notice from the o or rucllo Date Clly a to replace blic pld rty da g d thereby. INAL SP TION L / Date , pproved as Constructed Ig ature o pplicant Date WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN everett PUyI IC WORD S DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO 320C Cedar Street BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE Everett. WA 982C' CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS i Phone, 259-8810 PROJECT OVER 90 DAYS DURATION.