6801 EVERGREEN WAY 2016-01-01 MF Import

TYPE OR PRINT ONLY Application for I�U�LIC VvORKS PER�VII'T PUBLIC WORKS DEPF.RTMEN f 3200 Cedar Street Everetl, WA 98201 259-8810 �� Describe Proposed Work PROJECT ADDRESS (if known) Mailing Address �`T /L= City Attach four (4) copies of plans fer proposed work - Draw to scale and note the following if Date _—___�:yj�/�� , , Public Works Permit q _ �� / -- building Permit A Public Works Fee $,�_ � � ��.-� �.4�%�z—z�''�� I Zip ' Phone •PropeAy Lines "Outlina and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities •Centedine of street •Indicate North •Show any proposed grading changes •Sr�ow measurements PERMIT CONDITIONS: 1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. 2. All work shail 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. WD�� -,. �Ki `�` a,' ��,, t d ��. � 5 � ��nr� ��`;-��;,,� s�za � � � �, s�� :�� �, ,� pe✓ ��lN �,�1�/�iz e��`f�� 3�/��g y � �. /G� � ��in'"� �'� LS"�� FINAL IN8 EC. O Date Appmved as Constructed � � � V/ � 0 � ACKNOWLEDGEMENT OF CONDITIONS The undersigned owner/applicant hereby agrees to hold and save hamiless the City ol Everett from any and all claims for damage�, costs, expenses, or causes of action ihat may arise because of installation and maintenanc� 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 pu6lic property damaged there6y. WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DAT� PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIG[NTLY PURSUED TO CO!+1PLEP.ON. THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PR0.IECT OVER 90 DAYS DURATION.