6917 EVERGREEN WAY 2018-01-02 MF Import

Date_Z�12�b Application For PUBLIC W019KS PERMIT Print or Type Only Mailing Mailing Aooress Describe Proposed Work Project Address (if known) Attach four (4) copies of plans for proposed work • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities Public Works Pewr Bldg. Dept. Public Works Fee Total Fee $ Less e Foe Paid $ .Q-- Balance BalancDe Due $ City city r and note the foll44ing as applicable: • Centerline of street • Indicate North • Show any proposed grading changes • 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. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424.5555. S- ,��/L�ci4irJT F L INSPECTI0N Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8810 Date ACKNOWLEDGEMENT OF CONDITIONS 7� O 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 qqd further agr* to remove same upon notice from the City and to.f lace pub Ic o er dam g d thereby. / i SioKature of Applicant Date WORK AUTHORIZED BY THIS WIRMIT 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.