2315 W CASINO RD 2018-01-02 MF Import

Date aI� Application For PUBLIC WORKS PERMIT Print or Type Only fir,% 0a1(0W')r U2a _ Owner Mailing Xddress Public WOMa Per Bldg Depl e _ Public Work, Fee ` Total Fee Lee, •ppl Fee Paid i Balance Due i City Zip Phone C,/I to lye Applicant Mailing Address City Zip Phone Describe Proposed Work {d,__l _ im UJ Project Address (if known) q,'31 • J LU • , Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Cenle,"ne 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 DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls inr 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 Lccation Underground Service 48 hrsbefore you dig. TOLL FREE NUMBER 1.800.424.5555. z zrlvo Approved for Construction Date FINAL INSPECTION Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Ceder Street Everett, WA 98201 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save harm- less the City of Everett f,om 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 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 PROJECT OVER 90 DAYS DURATION.