7615 EVERGREEN WAY 2018-01-01 MF Import

,ate�c�' 7 � Applicalion For PUBLIC WORKS PERMIT Print or Type Only Address Address -TP na Describe Proposed Work _ Project Address (il known) �ti� PublmYloikg Pcrmil a BICB� Dept. • � % ,_,� PuElic Wo�ks Feo Tolal Foe 5 Less Ap01. Feo PeiO 5 Balanco Due 5 ��5�(f /�� 7a� �dn� ziP--�' Pnane ---� A 4��/ (_�i/S ) y57-G( )/ Zip hone Attach four (4) copies of plans for proposed work - Draw to scale and note the tollow:�g as applicable: • Froperly Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed ulililies - • Centerline ol street • Indicale Norih O Show any proposed grading changes • 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 per(ormed in accordance with this permit and current City ol Everett Design and Construction Slandarcls and Speci(ications. 3. Call Location Underground Service 48 hrs. hetore you dig. TOLL FREE NUMBER 1-800•424-5555. �C/QGiG Grloo��f PE=��T ��,��y Tss�Eo �/Z/�� � Approved for Construcfion Date FINAL INSPECTION Approved as Constructed evere« PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 98207 Phone: 259�8815 ACKNOWLEDGEMENT OF CONDITIONS fa � The undersigned owner/applicant hereby agrees �o hold and save harm- less the City of Everett from any and all claims lor damages, costs, expenses, or causes of action that may arise because of installation and maintenance of lhe improvement or other right-ol-way use hereto applied tor and further agrees to remove same upon notice Irom ihe City and to replace public properry damaged ihereby. Signature of Applicant Date WORK AUTHORIZED BY THIS PERMIT 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 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT GVER f,0 DAYS DURATION.