1405 SE EVERETT MALL WAY BASE FILE 2016-01-01 MF Import

Date�� Application For PUBLIC WORKS PERMIT Print or Type Only Describe Proposed Work �` S /T�� PuElic Worke Per�ml+l �" r� T Btap.Oeol � JL � PubllcWoekeFea s /pA/�_ Tolal Fae Lene AoO� Fee PaiO S Balente Dua S Zip rnone Pro)ect Address (if known) %?�� V .�L vv vvr�j� f./lrS� •�•� Attach four (4) copies o( plans for proposed work - Draw to sca�e and note the following as applicable: • Praperty Lines � Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities for • Centerline of street • Indicate North • Show any proposed grading changes • Show measurements u PERMIT CONDITIONS 1. All calls foi inspection shall be made 24 hrs. in advance • phone 259•881 5. 2� All work shetl bo pertormed in accordance with this permit and current L'ity of Everett Design and Construction Standards and Specifications. 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBEi4 1•800-424-5555. � ,�� ,��-a �-,�� ;�y ACKNOWLEDGEMENT OF CONDITIONS W H � � � O H � O a The undersigned owner/applicant hereby agrees to hold and save harm- less the Cily of Everett from any and all claims for damages, costs, expenses, or causes oF action that may arise because of installation �ap {�� and maintenance of the improvement or other right•of-way use hereto 1 0 applied (or and further agrees to remove same upon notice irom the �a�T Ciry and to replace public properry damaged ihereby. FINAL INSPECTION Date Approved es Construcled everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Streel EveretL WA 98201 Phone: 259•8815 Sigdature of ApplicanC �ace WORIC AUTHORIZED BY THIS PERMIT MUST E SfARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO COMPLETION. TFIIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PFOJECT OVER 50 DAYS DURATION.