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

Date 17 QU Nt✓ 8/0 Application For PUBLIC WORKS PERMIT Print or Type Only Public Wpnka Permit < 2 r Bldg_ Dept. e Public Works Fee dV Total Fee 5 Lase Appi. Fee Paid '> r- -�-- BalanceDue SA- C c n� ��0� �25 132"� AV- 5 .� I llevue U. �i�xo(o (04 3 43� Owner Mailing Address City Zip Phone ;o) ok,i-i, L E<zG-t SAME A-3 &9-- le Applicant o Mailing Address City Zip Phone Describe Proposed Work e1 �.1z It�C� '4'tjV 61QUY!(3I Q C'1 Uj Project Address (if known) 4, Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street PA • Outline and dimensions of all existing and • Indicate North v+ proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements M DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hr& in advance - phone 259.881 5. t� 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 his. before you dig. TOLL FREE NUMBER 1.800.424.5555. everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 `', Phone: 259.8815 H 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 and maintenance of the improvement or other right-of-way use hereto a plied for and further rees to remove same upon notice from the City and to replace publiproperty damaged thereby. Si nature of Applicant , uatu WORK AUTHORIZED BY THI PER IT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMITIS SUED 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.