7601 EVERGREEN WAY BASE FILE 2018-01-02 MF Import

Date��2 &96 Application For PUBLIC WORKS PERMIT Print or Type Only Kat-vi C�'Vaw Address Mailing Address Describe Proposed Work Cc�G J�4�iPpl NU' C CS2 �;{ Project Address (if known) -7 q Public Works Permit A Bldg. pact. s Public Works Fee Total Fee Less APPI Fee Paid $ F Balance Due S Phone Zip Phone Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: e 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 259.881 5. 2. All work shall be performed in accordance with this permit and nurrent 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. MpprST/e010 5(rUC I � �l �� Ir FINAL INSPECTION Date r Approved as Constructed everet[ PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259-8815 Z 01 0 am ACKNOWLEDGEMENT OF CONDITIONS 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 anY maintenance of the improvement or other right-of-way use hereto ap lied for and further g Xees to remove same upon notice from the to replace publi property damaged thereby. Sig ature of Applicant Date WO I K AUTHORIZED BY'THI P MIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS CO 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.