6924 COLBY AVE 2018-01-02 MF Import

r 1 L Application For PUBLIC WORKS PERMIT Print or Type Only Owner Mailing Applicant Mailing Address PLblm Works Permit a Bldg. Dept PLbhc works Fee •XQ n Total Fee $ Less APPL Fee Paid S Balance Due S aQ _ C_ City Zip Zip Phone Describe Proposed Work Kell V'� I FI �� Project Address (if known) —(CAL C /f, W' C Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Properly 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 DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrsin 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 11-8010.424-5555. �tLOs1 C. '11 %2-" C1n�V CKY Pe` r d IlA,'L, net A('AvG woI CLC Cie z.e .A, O a FINAL INSPECTION \ Approved as Constructed J ri PUBLIC WORKS DEPARTMENT Ever Cedar Street vorett, WA 98201 Phone: 259-8815 Date ACKNOWLEDGEMENT OF CONDII IONS 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 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. 1.1 F