215 SW EVERETT MALL WAY 2018-01-02 MF Import

I Date 3 -`7 Application For - PUBLIC WORKS PTMM -T, Print or Type Only Le Owner 7/6 S� Mailing Address Public Works Perrot 1 97/, Bldg. Dear.. F' 7 1 S'r). S i Public Works Fee $/ 7�-^ Total Fea Less Appr Fee Paid S Balance Due Phone Applicant Mailing Address City Zip Phone Describe Proposed Work A/H(Ai rrs vi , n iik9�f. rj ea la ,A W i, : iec w"ss (if known) 2/� cSGtl EdEPc Tl /Y>/fL""L liC/A✓ rtlacn Ip;tl, , .i copies of plans for proposed work - Draw to scale and note the following as applicable: • Property Lines • Centerline of street • Outline and dimensions of all existing and • Indicate North proposed structures on the lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements DO NOT WRITE BELOW THIS LINE O PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.881 5. 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 hrs. before you dig. TOLL FREE NUMBER 1-800-424.5555. Apb Oved I r Co SiructDate d7'=-4AMA FINAI N. PE(: I N rDate Approved as Constructed U O everett PUBLIC WORKS DEPARTMENT 3200 Cedar Street Everett, WA 98201 Phone: 259E%f3s &9—M \01 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 applied for and further agrees to remove same upon notice from the Cit nd ore ce publp pej fy damaged thereby. Ignature ofAVicant _ 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 BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.