3003 W CASINO RD BLDG 40-22 2018-01-02 MF Import

Date /3_ l fa A Application For PUBLIC WORKS PERMIT Print or Type Only Lilly Arty Public Works Permit a Blite Debt a !j//_74 LL7 Public Works Fee { oWl Fee Lees April Fee Pei { Balance Due { Phone r Applicant Mailing Address City Zip Phone Describe Proposed Work Project Address fit known) - ss/s3 Attach four (4) copies of plans for 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 lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements 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. Cell Location Underground Service 48 his. before you dig. TOLL FREE NUMBER 1.800-424.5555. Approved for Construction Date FINAL INSPECTION Date Approved as Constructed D PUBLIC WORKS DEPARTMENT 3200 Ceder Street Everett, WA 98201B20t Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS W H BONN M2 z O 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 PROJLCT OVER 90 DAYS DURATION