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

Date Application For PUBLIC WORKS PERMIT Print or Type Only Ovmer Applicant Describe Proposed Work Project Address (if known) v�/A 7�s' Mailinc� Address �� S'L' City C Zip PuEiic Works Permil s �� L // eiee�oeot • Publ¢ Works Fee 3� � Total Fea S Less AppL Fee PaiA $ _nn,�_ Balance Oue $ 3w�� .Jnl._ s _% i._ _i/» 7 G�% 9�10� ne ��y Ci7/.il�l --//7n_ h�-.� i ��-S�7 Attach four (4) copies of plans for proposed work • Drew to scale and note �he tollowing as applicable: , • Properry Lines • Centerline of street • Outline and dimensions of all exisling and • Indicate North preposed struct��res on ihe lot • Show any proposed grading changes • Existing and proposed utilities • Show measurements PERMIT CONDITIONS 1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 O. 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-$00•424•5555. �, %��►- �� r�� -- 6-/9 - 9 Z PUBLIC WORKS DEPARTMENT 320� Cedar Street Everelt, WA 98201 Phone:259•8870 W H � ACKNOWLE06EMENT OF CONDITIONS The undersigned owner/applicant here6y agrees to hold and save harm- less Ihe City ol Everett Irom any and all claims for damages, costs, expenses, or causes of aciion that may arise because of installation and maintenance of Ihe improvement or other right-of•way use hereto applied (gtaactfurther agreey(o remove same upon notice irom the City a�o replake public pr�eyly dam�7ed thereby. � / � Sgnat ol Applicant — D6te WO AUTHORIZED BY THIS PERMIT MUST BE TART D WITHIN 1 AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO B DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION.