1402 SE EVERETT MALL WAY WESTERN ROUND-UP 2016-01-01 MF Import

.• �. ' � • � Apolication For PUBLIC WORKS PERMIT Print or Type Only � Describe Proposed Work Project Addres� (if known) Adtlress �. City Attach four (4) coD�es of plans lor prcposed work - Draw to scnle and note tho fnllowing as • Property Lines • Oulline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities �./ � I Pu06c Works Permit a A— I BICB.Deol.�— rS�O r9�� L' , Public Works Fae Tolal Fee $ Le%s Apo� Fee Paitl S eni,�ce o�e s ��-aa >� ZIP —^-- P �� P • Centerline ol street • Indicate Norih • Show any proposed grading changes • Show measurements PERMIT CONDITIONS 1, All calls for inspection shall be made 24 hrs. ir advance - phone 259-8$10. 2. All wurk shall be peAormed in accordance witn this permit and current City of Everett Desiyn and Construction Standards and Specifications. 3. Call Location Underground Servi�e 48 hrs. before you dig. TOLL FREE NUMBEF 1•800-424•5555. ��. ��,��,�.�' .�/�,��,��.� ' Approved for Construction Date `:NAL INSPECTION Date Approved as Constructed everett PUBLIC WOPKS DEPARTMENT � 3200 C=Car Street Everett, WA 98201 Phone: ?59�8810 ACKNOWLEDGEMENT OF CONDITIONS W � � � � u � � � a The undersigned owner/applicant hereby agrees to hold and save harm- less the Ciry of Everett from any and all claims for damages, costs, expenaes, or causes of action that may arise because of installation and maintenance ot the improvement or other right-ol�way use hereto applied for and further agrees to remove same upon nolice from the City and lo replace public property damxged thereby. Signature of Applicant Date WOFK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED ANQ THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. THIS PEP.MIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON ThIS PROJECT OVER 90 DAYS DURATION.