2315 W CASINO RD 2018-01-02 MF Import

Date_��-1- Z� o Application For PUBLIC WORKS PERMIT Print or Type Only EI Puohc Works Permit a Bldg Dept Public Woas Fee 8Total Fee Lens APPI Fee Paid S Belenve Due 8 Mailing Address City Zip Phone Describe Proposed Work _9 _ ,�I�J L�Tf ci E 1e_—" )_I_1 TJ�2& Lf—C UJ Project Address lit known) Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable. • Property Lines • Centerline of street • Oullme and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE O 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 Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. z ROT ' �-z?� i aao O O a Approved for Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 tt. WA Street Everett. WA 98201 Phone. 2598810 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hcld 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 moimenance of the improvement or other right-ol-way use hereto applied for and further agrees to remove some 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 i PROJECT OVER 90 DAYS DURATION