20 SW EVERETT MALL WAY BASE FILE 2018-01-01 MF Import

DateJr "�lJ 7� Ap;lication Fcr PUBLIC WORKS PERMIT Print or Type Only n�ui eno •-� ��IY Zip Pubbc WaM1s Pnrm� pltlB. De01. � � �� _ Puobc Worxs Fco - Total Fce S 1e55Ap01 F?ePaN S e�i,��„ o��o S Phone Applicant Mailinc� qddress City Zip Phone Describe Proposed Wark Project Adtlress (il known) Attach lour (4) copies of plans for proposed work - Draw to scale and note the tollowing • P�openy Lines • Outline and dimensions o( all existing and propcsed structures on Ihe lot • Ezisting and proposed utilities • Centerline of streel • Indicate North • Show any proposed grading chanyes • Show measuremenis PERMITCONDITIONS t. All calls for inspection shall be made 24 hrs. in advance - phone 259•$$10. 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 Undergrourd Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-42Q-5555. Approved for Construction A � v/�v� // / � /�', � /� /2 G � l�c� V/j/ ,�f l Dale FINAL INSPECTION Date Approved as Constructed .. everett PUBLIC WORKS DEPARTMENT � 3200 Cedar Street Everett, WA 9A201 Phone: 259�8070 ACKNOWLEDGEMENT OF CONDITIONS W � � � � O � � O a The undersigned owner/applicant hereby agrees �o hold and save harm- less the City of Everelt Irom any and all claims for damages, costs. expenses, or causes of ac�ion �hat may �rise beCause of installation and maintenance of Ihe improvement or other rightroF�.vay use herelo applied br and lurther agrees to remove same upon no�ice irom tho City and to replace public property damaged thereby. Signalure ol Applicant Date WORK AUTHORIZE� 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 BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.