6917 EVERGREEN WAY 2018-01-02 MF Import

Application For PUBLIC WORKS PERMIT Print or Type Only Mailing Address Describe Proposed Work Project Address (if known) Attach four (4) copies of plans for proposed work - Drav - • Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities Pubbc works Permit r ��✓� Bldg. Dept. r _ Public works Fee Total Fee 3 Less AppL Fee Paid 8 r— Balance Duo S -77 Zip Phone Zip Phone scale and note the folldAing 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. Date Approved as Constructed everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259.8810 ACKNOWLEDGEMENT OF CONDITIONS n z O H The undersigned owner/applicant hereby agrees to he d 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 a d further aq to remove same upon notice from the City and tote lerjjy darnpgyd thereby. %/1 SigAature of Applicant / -bate WORK AUTHORIZED BY THIS JARMIT 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.